Malbul Kiran, Katwal Srijana, Maharjan Swojay, Shrestha Suraj, Dhital Roman, Rajbhandari Ashish Prasad
Nepalese Army Institute of Health Sciences College of Medicine, Sanobharyang, Kathmandu, Nepal.
Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
Ann Med Surg (Lond). 2021 Sep;69:102719. doi: 10.1016/j.amsu.2021.102719. Epub 2021 Aug 18.
Coronavirus disease-19 (COVID-19) is an infectious respiratory disease caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). Respiratory symptoms and flu-like presentation are the most defined clinical manifestations. However, gastrointestinal symptoms with acute abdomen have been reported in a small percentage, occasionally mimicking acute appendicitis. Hence, the diagnosis of COVID-19 should be suspected and investigated in every case of acute abdomen in the present situation.
We report a case of a 25-year-old male who presented with features of acute appendicitis. Despite the equivocal ultrasound results, he was scheduled for an emergency appendectomy for Alvarado's score 7 out of 10, who underwent a successful appendectomy. The patient had initially tested negative on an upper respiratory COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) with normal chest X-ray but few hours after the surgery patient developed a high-grade fever. An RT-PCR for COVID-19 was resent following a suspicion that came out to be positive.
Several case reports have suggested a probable association between COVID-19 and appendicitis. This case shows the limited effectiveness of clinical diagnosis for the surgical abdomen in COVID-19 patients as these two conditions share similar symptoms often needing a clinical vigilance.
This case reports acute appendicitis in a patient who tested positive for SARS-CoV-2 subsequently following emergency appendectomy highlighting the acute gastrointestinal presentation of COVID-19. This case exemplifies the necessity to be familiar with the gastrointestinal symptoms of COVID-19 and maintain a high level of suspicion for COVID-19 infection in cases of abdominal pain.
冠状病毒病-19（COVID-19）是由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的一种传染性呼吸道疾病。呼吸道症状和类似流感的表现是最典型的临床表现。然而，有小部分病例报告出现了伴有急腹症的胃肠道症状，偶尔会酷似急性阑尾炎。因此，在当前情况下，每一例急腹症患者都应怀疑并排查COVID-19。
我们报告一例25岁男性患者，表现为急性阑尾炎的特征。尽管超声检查结果不明确，但由于阿尔瓦拉多评分达7分（满分10分），他被安排进行急诊阑尾切除术，手术成功。该患者最初上呼吸道COVID-19逆转录聚合酶链反应（RT-PCR）检测为阴性，胸部X线检查正常，但术后数小时患者出现高热。在怀疑感染COVID-19后再次进行RT-PCR检测，结果呈阳性。
多篇病例报告提示COVID-19与阑尾炎之间可能存在关联。该病例显示，对于COVID-19患者的外科急腹症，临床诊断的有效性有限，因为这两种病症症状相似，常常需要临床保持警惕。
本病例报告了一名患者在急诊阑尾切除术后SARS-CoV-2检测呈阳性，并发急性阑尾炎，突出了COVID-19的急性胃肠道表现。该病例例证了熟悉COVID-19胃肠道症状并在腹痛病例中对COVID-19感染保持高度怀疑的必要性。
