EP.TU.203COVID-19 related myocarditis following laparoscopic appendicectomy

We report a 23 year-old male patient who presented to the emergency department with 2 days of central abdominal pain, with associated pyrexia, lethargy and nausea. Of note he had had COVID-19 in November 2020 which self-resolved. Examination revealed right sided abdominal and epigastric tenderness. His C-reactive protein was 302U/L but the remaining bloods unremarkable. The working diagnosis was unclear and a computed tomograph of the abdomen and pelvis arranged which revealed uncomplicated appendicitis with mesenteric lymphadenopathy. He underwent laparoscopic appendicectomy, revealing a macroscopically inflamed appendix without perforation or peritoneal contamination. Day 1 post-operatively, he deteriorated with acute hypoxia, tachypnoea and rigors. Additionally his inflammatory markers had increased. Respiratory physician advice was sought and an urgent computed tomograph pulmonary artertiogram performed, showing no pulmonary embolus but did show bilateral lower lobe consolidation and groundglass opacities in both lungs suspicious of COVID-19. Furthermore given his persistently low blood pressure, he underwent echocardiogram which revealed the presence of COVID-19 myocarditis and impaired left ventricular systolic dysfunction with an ejection fraction of 35%. He was admitted to the intensive care unit for blood pressure support and monitoring from a respiratory perspective. With such measures both his chest and cardiovascular function improved markedly and he was discharged on long-term cardioprotective medication. This highly rare long COVID-19 related complication following laparoscopic appendicectomy is highlighted for surgeons to be aware of and consider in cases of post-operative deterioration in patients with prior COVID-19 infection.