This report describes a rare clinical scenario of acute cholecystitis and acute appendicitis in a patient with COVID – 19 infection and highlights the diagnostic and management challenges of dual surgical pathologies. The patient initially presented with severe right upper quadrant pain, nausea, and vomiting. Laboratory and radiological findings were consistent with cholecystitis and an incidental appendiceal fecalith. Conservative outpatient management was initially performed as per the patient's preference. He returned with worsening symptoms and subsequently tested positive for COVID-19, necessitating further delay in surgical intervention. Despite antibiotic therapy, his condition progressed to include clinical and radiological evidence of acute appendicitis with localised peritonitis. The patient ultimately underwent successful laparoscopic appendectomy and cholecystectomy under strict COVID-19 protocols. Intraoperative findings confirmed a perforated retro-ileal appendix and an acute on chronic cholecystitis. We discuss the potential role of SARS-COV2 in the pathophysiology of abdominal surgical pathologies. This case report underscores the importance of high clinical suspicion, vigilant monitoring, and evolving management strategies in patients presenting with abdominal pain and active COVID-19 infection. This is particularly true with multiple acute abdominal pathologies. It reinforces the need to balance timely surgical intervention with infection control measures in COVID-19 positive patients.

Keywords: Acute cholecystitis; Acute appendicitis; COVID-19; Dual pathology