COVID-19 Positive in Nasopharyngeal Swab but Negative in Peritoneal Fluid: Case Report of Perforated Appendicitis

COVID-19 has drastically changed hospital systems from a microcosmic to macrocosmic level, specifically for surgical practices worldwide. COVID-19 surgical guidelines are continuing to evolve as we deepen our understanding of the virus. A particular point of interest is the possibility of aerosolization of COVID-19 during laparoscopic procedures. There is much uncertainty of the pathogenicity of COVID-19 and insufficient data on the presence and extent of viral load in different body fluids, specifically in peritoneal fluid. We present a case of a 27-year-old male who was diagnosed with acute appendicitis and found to be COVID-19 positive postoperatively. Intraoperative peritoneal fluid sampling was obtained and tested for COVID-19 through real-time reverse transcription polymerase chain reaction (RT-PCR) targeting N1 and N2 proteins. COVID-19 was not detected in RT-PCR test in the peritoneal fluid collected; however, it was detected in the nasopharyngeal RT-PCR. The patient had prolonged stay in the hospital secondary to COVID-19 symptoms. Currently, there is very limited and inconclusive evidence on the presence of COVID-19 in peritoneal fluid. We present the first paper discussing perforated bowel, in which COVID-19 is not detected in peritoneal fluid. This case report provides more insight regarding shaping guidelines for surgeries in patients with COVID-19.