Acute appendicitis in patients with COVID-19

ABSTRACT

Objective. The aim of the work was to analyze the results and treatment of acute appendicitis (AA) in patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19. Material and methods. From March 16, 2020 to October 31, 2021, 139 patients with suspected AA were tread. In 104 patients (62 men and 42 women) the diagnosis of AA was confirmed. Inclusion criteria were AA, a positive PCR (polymerase chain re-action) result for COVID-19, or a characteristic picture of viral pneumonia for COVID-19 based on computed tomography (CT). To clarify the diagnosis of acute appendicitis, all patients underwent CT scan of the abdominal organs. Results. When evaluating the symptoms of AA in patients with COVID-19, no specific signs were identified. The systematic inflammatory response could be due to both surgical disease and viral infection, making it difficult to interpret the chang-es. But, in 88 patients (84.61%) in the blood test was leukocytosis from 11.81 to 34.83·109/l, which is uncommon for patients with COVID-19 at the onset of the disease. The average time from the onset of clinical manifestations of AA to the operation was 57±14 hours. 139 diagnostic laparoscopies were performed. The diagnosis of AA was confirmed in 104 patients. 102 patients underwent laparoscopic appendectomy with pelvic drainage. One patient had laparotomy, appendectomy, intestinal intubation. One patient had laparoscopic resection of Meckel’s diverticulum plus appendectomy. A positive PCR result for SARS-CoV-2 effu-sion from the abdominal cavity was confirmed in 45 out of 75 patients (60%). According to the results of a pathomorphological study, 89 (85.58%) patients had phlegmonous appendicitis, 8 (7.69%) had gangrenous appendicitis, and 7 (6.73%) had gangre-nous-perforated appendicitis. Mortality was 0.96% (1 patient). Conclusion. Diagnostic problems of AA in patients with COVID-19 are associated with difficulties in interpreting local symptoms and systemic inflammatory response. Laparoscopy is the leading diagnostic method for suspected AA, including patients with COVID-19. In the absence of severe pneumonia, laparoscopic appendectomy is possible in most patients. All operations should be carried out in accordance with anti-epidemic measures. The clinical significance of detecting SARS-CoV-2 in the abdominal cavity needs further evaluation. The prognosis for patients is determined to a greater extent by the course of COVID-19. The tactics of treatment of patients with COVID-19, for whom surgical intervention is associated with an extremely high risk, needs to be clarified. © 2022, Media Sphera Publishing Group. All rights reserved.