Diagnosis and treatment of acute appendicitis in patients with the new coronavirus infection COVID-19

Abstract

The work is dedicated to the features of the clinic, diagnosis, and treatment of acute appendicitis (AA) in patients with the new coronavirus infection (COVID-19). An analysis of 73 cases of diagnosis and treatment of AA in patients with COVID-19 in an infectious diseases hospital was conducted. In patients with COVID-19, immunopathological reactions, disturbances of consciousness, and the administration of antibacterial and anti-inflammatory therapy complicated the diagnosis of concurrent AA, leading to a smoothing or complete absence of local pain symptoms, an inability to fully collect complaints and medical history, and the presence of leukopenia. In patients with severe COVID-19 with disturbances of consciousness according to the Glasgow Coma Scale up to 9–13 points, CT grade 4, and respiratory failure of the 3rd degree, the basis for targeted diagnostic search for acute surgical pathology of the abdominal cavity of an inflammatory nature was the progressive increase in leukocytosis in the complete blood count, refractory to the administered antibacterial and anti-inflammatory therapy, in combination with values of CRP and procalcitonin (PCT) exceeding their average values in the group of patients with COVID-19. With an increase in the severity of COVID-19, the final diagnosis of AA was possible only when using additional instrumental diagnostic methods and performing diagnostic laparotomies (laparoscopies). A direct correlation was found between the severity of COVID-19 and an increase in the frequency of gangrenous forms of AA and secondary AA. The number of postoperative complications in AA was directly correlated with the severity of COVID-19. Fatal outcomes occurred only in patients with severe COVID-19 due to the progression of multiorgan failure.