COVID-19 not detected in peritoneal fluid: a case of laparoscopic appendicectomy for acute appendicitis in a COVID-19-infected patient

Langenbecks Arch Surg. 2020 May;405(3):353-355. doi: 10.1007/s00423-020-01891-2. Epub 2020 May 9.


Purpose: COVID-19 greatly affected millions and affected the way we practice with heightened posture in the way we treat surgical patients. Surgical consensus guidelines are recommending caution in the use of laparoscopy for the theoretical possibility of viral transmission from aerosolization of tissue and peritoneal fluid during surgery. However, there has yet to be proof of COVID-19 being present in peritoneal fluid, justifying the consensus statements. We aim to assess the presence of COVID-19 in peritoneal fluid.

Methods: We performed a laparoscopic appendicectomy for a COVID-19-infected patient with acute appendicitis. Peritoneal fluid and peritoneal washings were collected and sent for COVID-19 PCR.

Results: The peritoneal fluid sample collected on entry and at the end of the operation was negative for COVID-19 on PCR. The patient had an uneventful recovery from surgery.

Conclusions: This case revealed that COVID-19 was not detected in peritoneal fluid and peritoneal washings in a patient infected with COVID-19. This study provides novel preliminary data in the investigation of COVID-19 transmission from laparoscopy-related aerosolization.

Keywords: COVID-19; Laparoscopy; Peritoneal fluid; Safety; Surgery.

Publication types

  • Case Reports

MeSH terms

  • Appendectomy / methods*
  • Appendicitis / diagnosis
  • Appendicitis / surgery*
  • Ascitic Fluid / virology*
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques / methods
  • Coronavirus Infections / diagnosis*
  • DNA, Viral / isolation & purification
  • False Negative Reactions
  • Follow-Up Studies
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control*
  • Laparoscopy / adverse effects
  • Laparoscopy / methods
  • Male
  • Occupational Health
  • Pandemics
  • Patient Safety
  • Peritoneal Lavage / methods
  • Pneumonia, Viral / diagnosis*
  • Real-Time Polymerase Chain Reaction / methods
  • Risk Assessment
  • Treatment Outcome
  • Young Adult


  • DNA, Viral