Hypoxic respiratory failure in acute appendicitis: A bronchoperitoneal fistula as the presenting symptom of appendicitis in the setting of pediatric COVID-19.

Symptomatic COVID-19 less frequently affects the pediatric population and is often associated with atypical presenting symptoms. Here we describe a nine-year-old patient who presented with acute hypoxic respiratory failure and was found to have perforated appendicitis, intra-abdominal abscess, and bronchoperitoneal fistula. The rapid progression of this pathology, complex critical care decision making, and ultimate surgical management has not been previously described.

Despite the Safety of Preoperative Cefazolin for Patients With Non-anaphylactic Penicillin Allergy, 20% of Practitioners Avoid Its Use.

Cefazolin is commonly used for surgical site infection prophylaxis due to its low cost and effective coverage. However, it is controversial to use cefazolin in patients with a penicillin allergy despite the cross-reactivity between cefazolin and penicillin being only 1%. Ample literature shows that it is safe to use cefazolin in patients with non-anaphylactic penicillin allergies.