In Reply

SARS-CoV-2 Pandemic—A Complicated Case of Appendicitis by Dr. med. Teresa Schreckenbach, Dr. med. Maximilian Lahrsow, Norbert Fritsch in issue 20/2020

We would like to thank Prof. Schilling and Dr. Becker for their critical comment. The option of antibiotic therapy was indeed discussed with the patient and within the team, because it was a case of uncomplicated appendicitis, according to the description of Bhangu et al. (1). However, the white blood cell count could not be used as a criterion to evaluate the patient’s appendicitis because of the concomitant COVID-19 disease with leukopenia. Furthermore, approximately 20% of patients in whom antibiotic therapy is attempted may require appendectomy during the primary inpatient stay (2).

Since the young patient had, on the one hand, no signs of respiratory impairment at the time of presentation and, on the other hand, the further course of COVID-19 was not predictable, we made the decision against the risk of secondary appendectomy which we may have had to perform in a patient with progressive lung disease.

Now, data on emergency surgical procedures in patients with SARS-CoV-2 infection are available which can be used to identify additional risk factors for lung complications. These include, among others: age >70 years, male gender, malignancies, and pre-existing conditions. These risk factors were not present in the patient (3). In each case, however, an individual risk/benefit assessment is required.

DOI: 10.3238/arztebl.m2021.0030

Corresponding author

Dr. med. Teresa Schreckenbach

Klinik für Allgemein-, Viszeral- und Transplantationschirurgie

Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt,

Frankfurt, Germany

Conflict of interest

The authors of both contributions declare no conflict of interest.

References

1. Bhangu A, Soreide K, Di Saverio S, Assarson JH, Drake FT: Acute Appendicitis: modern understanding of pathogenensis, diagnosis, and management. Lancet 2015; 386: 1278–87

2. Varadhan KK, Neal KR, Lobo DN: Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ 2012; 344: e2156

3. COVIDSurg Collaborative: Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet 2020; 396: 27–38

4. Schreckenbach T, Lahrsow M, Fritsch N: SARS-CoV-2 pandemic—a complicated case of appendicitis. Dtsch Arztebl Int 2020; 117: 364