To the Editor:
Recently we read with great interest an article in your journal about changes in acute appendicitis presentation and severity of illness during the pandemic.1 There is no doubt that the treatment of acute appendicitis in this particular period is more challenging, as reported, it subtly affects the structure of the disease. Acute appendicitis, as a common acute abdominal disease requiring surgical operation or endoscopic surgery, brings more thinking and challenges to clinicians. We should explore whether the cause of acute appendicitis has its own particularity in the context of coronavirus disease2019 (COVID-19). At the same time, acute appendicitis should arouse the attention of clinicians for some new concepts in the midst of COVID-19.
COVID-19 is an acute infectious disease characterized by respiratory symptoms, yet over time it has been demonstrated that more and more other systems are affected, including the digestive system. To the best of our knowledge, acute appendicitis is a digestive tract disease mainly characterized by abdominal symptoms, which are obviously easily confused with the abdominal symptoms of COVID-19. Based on this consideration, we should never ignore acute appendicitis directly induced by novel coronavirus infection of the appendix, so as to prevent the spread of pandemic caused by misdiagnosis and missed diagnosis in the clinical diagnosis and treatment process. It is time for us to come up with new concepts: acute appendicitis-like symptoms of COVID-19; acute appendicitis combined with COVID-19; and novel coronavirus acute appendicitis. It is particularly important in the context of COVID-19 pandemic.
It is easy for us to take their differences literally. Acute appendicitis like symptoms of COVID-19 means that COVID-19 is characterized by abdominal symptoms similar to acute appendicitis. Although acute appendicitis combined with COVID-19 means that the occurrence of the 2 diseases overlap in time but is not cause-and-effect. However, novel coronavirus acute appendicitis indicates that acute appendicitis is caused by novel coronavirus infection. Although no novel coronavirus has been reported to induce acute appendicitis, coronavirus has been isolated from appendix tissue.2 This means that novel coronavirus has a potential risk of triggering acute appendicitis because viral infection of the appendix is one of the causes of acute appendicitis. From this point of view, there is an urgent need for relevant studies and reports to confirm.
As the pandemic continues to spread and poses more uncertain risks, it is of great importance to accurately judge acute appendicitis in clinical practice. Therefore, it is necessary to determine the pathological features of coronavirus to guide doctors in the diagnosis and treatment of acute appendicitis. After all, in this special time, we do not want to cause missed diagnosis or misdiagnosis of novel coronavirus related disease.
Funding/Support
Scholarship of Southeast University (Project No. 189351).
Conflict of interest/Disclosure
The authors declare that they have no competing interests.
References
- 1.Neufeld M.Y., Bauerle E., Eriksson E., et al. Where did the patients go? Changes in acute appendicitis presentation and severity of illness during the coronavirus disease 2019 pandemic: a retrospective cohort study. Surgery. 2021;169:808–815. doi: 10.1016/j.surg.2020.10.035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ahmad S., Ahmed R.N., Jani P., Ullah M., Aboulgheit H. SARS-CoV-2 isolation from an appendix. J Surg Case Rep. 2020;2020:rjaa245. doi: 10.1093/jscr/rjaa245. [DOI] [PMC free article] [PubMed] [Google Scholar]