Appendicitis with concurrent COVID-19 infection in a patient during the third trimester of pregnancy

Abstract

This article presents an unusual case of appendicitis in pregnancy complicated by the novel coronavirus (SARS-CoV-2). The novel coronavirus has affected the way medicine is practised across most parts of the world with over 160 000 000 global cases to date. Tackling management of these cases is more complex when other pathological processes are ongoing. Appendicitis is a common occurrence in pregnancy, with most obstetric centres seeing about one or two cases a year. Though maternal morbidity and mortality are relatively unimpacted by this event, fetal loss and preterm labour are common sequelae. This case involves a 35-year-old woman presenting in her third trimester with abdominal pain and who went on to be diagnosed with concurrent appendicitis and SARS-CoV-2 infection. Although spinal anaesthesia would be most appropriate as it avoids aerosol generation, general anaesthetic techniques were indicated due to thrombocytopenia in this case. She underwent a successful appendicectomy, although preterm delivery was indicated as a result of maternal and fetal concerns.

COVID‑19‑associated acute appendicitis in adults. A report of five cases and a review of the literature

“…In a previous study, SARS-CoV-2 infection was established by a positive RT-PCR test of an appendicular tissue sample ( 12 ). Laboratory test results have revealed increased white blood cell counts in the majority of cases ( 6 , 11 , 14 , 16 ), while lymphopenia, a hallmark of COVID-19 infection ( 18 ), has been observed in some cases ( 6 , 15 , 17 ), including the cases described in the present study. The diagnosis of COVID-19-associated acute appendicitis is established either by an abdominal U/S ( 6 ) or by an abdominal CT scan ( 10-16 ).…”

“…The diagnosis of acute appendicitis may precede the diagnosis of SARS-CoV-2 infection, may follow the diagnosis of SARS-CoV-2 infection or may be simultaneous to the diagnosis of SARS-CoV-2 infection ( 6 , 10-17 ). COVID-19-associated acute appendicitis has also been reported during pregnancy ( 17 ).…”

“…The diagnosis of COVID-19-associated acute appendicitis is established either by an abdominal U/S ( 6 ) or by an abdominal CT scan ( 10-16 ). In a previous study reporting a case of a pregnant woman, abdominal magnetic resonance imaging was performed to confirm the diagnosis ( 17 ). In all cases, resected appendicular tissues were sent for a histological examination, which revealed acute appendicitis ( 6 , 11-17 ).…”

“…All patients with COVID-19-associated acute appendicitis reported in the literature have had an uneventful post-operative follow-up and favorable outcomes, even in cases of perforation ( 11 , 16 - 17 ) and sepsis ( 12 ). The cases of COVID-19-associated acute appendicitis found in the literature are summarized in Table I .…”