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Fadhle MJ, Al-Mayoof AF. Acute Appendicitis in Children in the Era of Covid-19. Afr J Paediatr Surg 2024:01434821-990000000-00014. [PMID: 39137097 DOI: 10.4103/ajps.ajps_72_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/25/2023] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Abdominal pain is a common complaint encountered by paediatric surgeons. This complaint could be related to surgical or non-surgical causes. With coronavirus disease 2019 (COVID-19), the incidence of abdominal pain has increased and mimicked acute appendicitis in paediatric patients. OBJECTIVE The objective of this study was to assess the impact of the COVID-19 pandemic on paediatric acute appendicitis in terms of demographic data (age and sex), and operative findings, specifically, the complicated appendicitis and negative appendectomy rates. MATERIALS AND METHODS This retrospective cohort study reviewed the records of children aged 5-15 years, who were diagnosed with acute appendicitis and underwent surgery between January 2018 and December 2021. The patients were divided into pre-pandemic and pandemic groups. Demographic, operative and histopathological findings were compared between the two groups. RESULTS A significant increase in the incidence of acute abdominal pain amongst the admitted children (39.8% vs. 32.7%, P < 0.0001) and a significant decrease in the incidence of acute appendicitis (27% vs. 33%, P < 0.013) were observed in the pandemic group. An associated non-significant increase in the rates of complicated appendicitis (30% vs. 26%, P = 0.299) and negative appendectomy (5.8% vs. 3.8%, P = 0.359) was noted. During the pandemic period, no statistically significant differences were found between polymerase chain reaction (PCR)-positive and PCR-negative patients in complicated appendicitis or negative appendectomy rates (30% vs. 29.7%, P = 0.841, and 6.7% vs. 4.2%, P = 0.424, respectively). CONCLUSION COVID-19 is associated with an increased incidence of acute abdominal pain in children but a decreased rate of acute appendicitis. The latter tends to present at a younger age than usual. The rates of complicated appendicitis and negative appendectomy increased but were not significantly affected by the pandemic or severe acute respiratory syndrome coronavirus 2 infection status.
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Affiliation(s)
- Muhamed Jassim Fadhle
- Department of Surgery, Division of Pediatric Surgery, Mustansiriyah University, College of Medicine, Baghdad, Iraq
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2
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Amoroso A, Di Stasio F, Ranucci G, Betalli P, Cheli M, Dalla Rosa D, D’Anna C, Gaglione G, Giannotti G, Licini L, Mandato C, Massazza G, Orlando F, Morotti D, Rocco M, Sonzogni A, Tipo V, Verdoni L, D’Antiga L, Norsa L. Thrombotic Features as the Primary Cause of SARS-CoV-2 Related Acute Abdomen in Children. J Pediatr Gastroenterol Nutr 2023; 77:474-478. [PMID: 37490586 PMCID: PMC10501346 DOI: 10.1097/mpg.0000000000003893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES We performed a retrospective case control study to evaluate the histological characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pediatric patients undergoing laparoscopic exploration for acute abdomen symptoms. To our knowledge this is the first study that analyzes histopathological characteristics of abdominal tissues in SARS-CoV-2 children. STUDY DESIGN We enrolled 8 multisystem inflammatory syndrome in children (MIS-C) patients and 4 SARS-CoV-2 positive patients who underwent intestinal resection versus 36 control appendectomies from 2 pediatric tertiary referral centers between March 2020 and July 2021. Surgical resection samples were evaluated on several histological sections focusing on general inflammatory pattern and degree of inflammation. Peculiar histological features (endotheliitis and vascular thrombosis) were semi-quantitatively scored respectively in capillary, veins, and arteries. RESULTS All SARS-CoV-2 related surgical samples showed thrombotic patterns. Those patterns were significantly less frequent in SARS-CoV-2 negative appendectomies ( P = 0.004). The semi-quantitative score of thrombosis was significantly higher ( P = 0.002) in patients with SARS-CoV-2 related procedures. CONCLUSIONS Our results showed that SARS-CoV-2 can cause thrombotic damage in abdominal tissues both in the acute phase of the infection (SARS-CoV-2 related appendectomies) and secondary to cytokine storm (MIS-C).
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Affiliation(s)
- Angela Amoroso
- From the Paediatric Department, University of Milano Bicocca, Fondazione MBBM, Onlus San Gerardo Hospital, Monza, Italy
| | - Fabiana Di Stasio
- From the Paediatric Department, University of Milano Bicocca, Fondazione MBBM, Onlus San Gerardo Hospital, Monza, Italy
| | - Giusy Ranucci
- the Paediatric Department, AORN Santobono Pausilipon, Napoli, Italy
| | - Pietro Betalli
- the Paediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Cheli
- the Paediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Dalla Rosa
- the Paediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Carolina D’Anna
- the Paediatric Emergency Department, AORN Santobono Pausilipon, Napoli, Italy
| | - Giovanni Gaglione
- the Paediatric Surgery Department, AORN Santobono Pausilipon, Napoli, Italy
| | - Giulia Giannotti
- the Paediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lisa Licini
- the Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Claudia Mandato
- the Paediatric Department, AORN Santobono Pausilipon, Napoli, Italy
| | | | | | - Denise Morotti
- the Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Rocco
- the Department of Pathology, AORN Santobono Pausilipon, Napoli, Italy
| | | | - Vincenzo Tipo
- the Paediatric Emergency Department, AORN Santobono Pausilipon, Napoli, Italy
| | - Lucio Verdoni
- the Paediatric Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo D’Antiga
- the Paediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo Norsa
- the Paediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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Fadgyas B, Őri D, Vajda P. [Effect of the COVID-19 pandemic on the outcome of testicular torsion in children]. Orv Hetil 2023; 164:1367-1372. [PMID: 37660346 DOI: 10.1556/650.2023.32854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/16/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic influenced not only the elective, but the acute surgeries also, all around the world. Some authors found more delayed cases and more orchiectomies performed in childhood because of testicular torsions during the pandemic. OBJECTIVE To examine the impact of the COVID-19 pandemic on the treatment of childhood testicular torsion and the frequency of semicastration due to torsion at the first author's institute. METHODS A retrospective observational cohort study was performed in a representative Hungarian centre. Boys under 18 years of age operated with testicular torsion were divided into two groups: before COVID-19 (BC; 01/07/2017-31/12/2019) and during COVID-19 (DC; 01/01/2020-30/06/2022) pandemic. PARAMETERS elapsed time between the first symptom and arrival at the hospital (<24 h or >24 h), elapsed time to start the surgical procedure since the arrival to the hospital and the rate of semicastration were analysed. For statistical analysis, Mann-Whitney U and chi2 tests were used. RESULTS During the study period, altogether, 100 patients (45 BC and 55 DC) were operated on testicular torsion. Statistically significant difference was found between the two timeframes: in the elapsed time from the first symptom and arrival at the hospital (p = 0.048). During the pandemic surgeries started earlier (1.5; 2.5 h) than before the pandemic (1.5; 3.25 h, p = 0.01). No difference was found in the frequency of semicastration between the groups (p = 0.594). DISCUSSION Contrary to the literature, during the COVID-19 pandemic, patients with testicular torsion arrived earlier at the hospital, and surgeries were started earlier, than before the pandemic at the investigated institute. CONCLUSION The reason behind this accelerated care pathway might be the absence of less severe cases during the COVID-19 period. When people are more prone to stay home, if it does not seem necessary to seek help for any kind of non-urgent medical problem. Orv Hetil. 2023; 164(35): 1367-1372.
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Affiliation(s)
- Balázs Fadgyas
- 1 Heim Pál Országos Gyermekgyógyászati Intézet, Sebészeti és Traumatológiai Osztály Budapest, Üllői út 86., 1089 Magyarország
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Gyermekgyógyászati Klinika, Manuális Tanszék Pécs Magyarország
| | - Dorottya Őri
- 3 Heim Pál Országos Gyermekgyógyászati Intézet, Mentálhigiéniai Központ Budapest Magyarország
- 4 Semmelweis Egyetem, Általános Orvostudományi Kar, Magatartástudományi Intézet Budapest Magyarország
| | - Péter Vajda
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Gyermekgyógyászati Klinika, Manuális Tanszék Pécs Magyarország
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Differentiating abdominal pain due to COVID-19 associated multisystem inflammatory syndrome from children with acute appendicitis: a score system. Pediatr Surg Int 2023; 39:151. [PMID: 36897476 PMCID: PMC9999317 DOI: 10.1007/s00383-023-05432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Differentiating abdominal pain due to coronavirus disease (COVID-19)-associated multisystem inflammatory syndrome (MIS-C) in children with acute appendicitis (AA) can cause diagnostic dilemmas. This study aimed to evaluate the efficacy of a previously described scoring system and improve its diagnostic ability in differentiating between these diseases. METHODS This study was conducted between March 2020 and January 2022. Patients who had MIS-C with gastrointestinal system (GIS) involvement and patients who underwent surgery for appendicitis were included. First, all patients were evaluated using the new scoring system (NSS). The groups were compared by adding new MISC-specific parameters to NSS. The scoring system was evaluated using propensity score matching (PSM). RESULTS A total of 35 patients with abdominal pain due to GIS involvement in MIS-C (group A) and 37 patients with AA who had ALT, PRC, and D-dimer results at their first admission (group B) were included in the study. The mean age of patients in group A was lower than that of patients in group B (p < 0.001). False NSS positivity was found in 45.7% of the patients with MIS-C. Lymphocyte (p = 0.021) and platelet counts (p = 0.036) were significantly lower in the blood count and serum D-dimer (p = 0.034), C-reactive protein (CRP) (p < 0.001), and procalcitonin (p < 0.001) were significantly higher in the MIS-C group. We created a scoring system called the Appendicitis-MISC Score (AMS) using the NSS and new parameters. The sensitivity and specificity of AMS diagnostic scores were 91.9% and 80%, respectively. CONCLUSION MIS-C with GIS involvement may present as acute abdomen. It is difficult to differentiate this condition from acute appendicitis. AMS has been shown to be useful for this differentiation.
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Sag S, Sonmez Y, Sahin EG, Guzel B, Cay A. Small bowel ischaemia secondary to COVID-19 disease in children: A case report and review of the literature. J Paediatr Child Health 2023; 59:567-569. [PMID: 36722829 DOI: 10.1111/jpc.16341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Sefa Sag
- Department of Pediatric Surgery, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yagmur Sonmez
- Department of Pediatric Surgery, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ebru G Sahin
- Department of Pediatrics, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bulent Guzel
- Department of Pediatrics, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ali Cay
- Department of Pediatric Surgery, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Pektaş A, Bükülmez A, Çeleğen M, Eker İ. Rash and Gastrointestinal Dysfunction May Indicate Cardiac Involvement in Children with Multisystem Inflammatory System Associated with Coronavirus Disease 2019. J PEDIAT INF DIS-GER 2023. [DOI: 10.1055/s-0042-1760411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractThis study aims to investigate the management of children diagnosed with “multisystem inflammatory syndrome” (MIS-C) potentially associated with coronavirus disease 2019 (COVID-19) at a tertiary health center. This is a retrospective review of 34 children who were diagnosed with MIS-C at the pediatrics department of the study center from August 2021 to December 2021. Data related to age, sex, body mass index, vital findings, laboratory data, clinical symptoms, ultrasonography, and echocardiography findings were acquired from hospital records. Cardiac markers were compared with respect to clinical symptoms and imaging. Fever (91.2%), rash (50%), and abdominal pain (44.1%) were the most observed symptoms. Echocardiography visualized mild mitral regurgitation in 12 patients (35.3%), pericardial effusion in 9 patients (26.5%), and mild coronary dilatation in 9 patients (26.5%). All patients received corticosteroids, whereas acetylsalicylic acid was prescribed in 29 patients (85.3%) and intravenous immunoglobulins were administered in 21 patients (61.8%). Serum probrain natriuretic peptide concentrations were significantly higher in MIS-C patients with rash than those without rash (9,592.2 ± 7,764.5 vs. 1,501.2 ± 1,385.4 pg/mL, p = 0.021). Serum troponin T concentrations were significantly higher in MIS-C patients with ileitis than those without ileitis (0.026 ± 0.024 vs. 0.008 ± 0.003 µg/L, p = 0.013). Serum troponin T concentrations were also significantly higher in MIS-C patients with pericardial effusion than those without pericardial effusion (0.022 ± 0.020 vs. 0.008 ± 0.007 µg/L, p = 0.036). The presence of rash and sonographic visualization of ileitis might act as signs for cardiac involvement in children exposed to COVID-19. To assess the cardiac involvement in MIS-C patients, cardiac enzymes should be measured and echocardiography examination should be performed.
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Affiliation(s)
- Ayhan Pektaş
- Division of Pediatric Cardiology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Ayşegül Bükülmez
- Division of Pediatric Gastroenterology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Mehmet Çeleğen
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - İbrahim Eker
- Division of Pediatric Hematology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
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Unny AK, Rajashree P, Sundararajan L, Sankar J. Abdominal Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Experience. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Does Multisystem Inflammatory Syndrome Only Mimic Acute Appendicitis in Children or Can It Coexist: When Should We Suspect MIS-C? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081101. [PMID: 36013568 PMCID: PMC9416076 DOI: 10.3390/medicina58081101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Acute abdominal pain in children has been noticed to be a primary reason to seek medical attention in multisystem inflammatory disorder (MIS-C), which can prevail separately or together with acute appendicitis. Our aim was to distinguish regular appendicitis cases from MIS-C and to suggest the best clinical and laboratory criteria for it. Materials and methods: Cases of patients, admitted to the Pediatric Surgery Department over a six-month period in 2021, were retrospectively analyzed. Confirmed MIS-C or acute appendicitis cases were selected. MIS-C cases were either separate/with no found inflammation in the appendix or together with acute appendicitis. Acute appendicitis cases were either regular cases or with a positive COVID-19 test. Four groups were formed and compared: A-acute appendicitis, B-MIS-C with acute appendicitis, C-MIS-C only and D-acute appendicitis with COVID-19. Results: A total of 76 cases were overall analyzed: A-36, B-6, C-29 and D-5. The most significant differences were found in duration of disease A—1.4 days, B—4.5 days, C—4 days, D—4 days (p < 0.0001), C reactive protein (CRP) values A-19.3 mg/L B-112.5 m/L, C-143.8 mg/L and D-141 mg/L (p < 0.0001), presence of febrile fever A-13.9%, B-66.7%, C-96.6% and D-40% (p < 0.0001) and other system involvement: A 0%, B 100%, C 100% and D 20%. A combination of these factors was entered into a ROC curve and was found to have a possibility to predict MIS-C in our analyzed cases (with or without acute appendicitis) with an AUC = 0.983, p < 0.0001, sensitivity of 94.3% and specificity of 92.7% when at least three criteria were met. Conclusions: MIS-C could be suspected even when clinical data and performed tests suggest acute appendicitis especially when at least three out of four signs are present: CRP > 55.8 mg, symptoms last 3 days or longer, febrile fever is present, and any kind of other system involvement is noticed, especially with a known prior recent COVID-19 contact, infection or a positive COVID-19 antibody IgG test.
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Rouva G, Vergadi E, Galanakis E. Acute abdomen in multisystem inflammatory syndrome in children: A systematic review. Acta Paediatr 2022; 111:467-472. [PMID: 34751972 DOI: 10.1111/apa.16178] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022]
Abstract
AIM Multisystem inflammatory syndrome in children (MIS-C), a rare severe complication of SARS-CoV-2 infection, has been recently reported to mimic acute abdomen and lead to surgical interventions, posing challenges for clinicians. In this systematic review, we evaluated the rate of acute abdomen and abdominal surgical emergencies in children with MIS-C. METHODS Systematic review of all MIS-C cases presented with acute abdomen. RESULTS A total of 385 patients with MIS-C, from 38 studies, were included. Gastrointestinal manifestations were prominent in 233/385 (60.5%) children. Acute abdomen was noted in 72/385 (18.7%) of MIS-C cases and in 72/233 (30.9%) of MIS-C cases with gastrointestinal symptoms. Final diagnoses were mostly non-surgical (55/72, 76.4%), such as mesenteric lymphadenitis (23/72, 31.9%), terminal ileitis/ileocolitis (19/72, 26.4%), free abdominal fluid/ascites (8/72, 11.1%) and paralytic ileus (3/72, 4.2%). Laparotomy was performed in 35/72 (48.6%) of children with MIS-C, and acute abdomen and was proven unnecessary in 18/35 (51.4%) cases. True abdominal surgical emergencies, such as appendicitis and obstructive ileus, were confirmed in 17/72 (23.6%) cases. CONCLUSION MIS-C often presents with acute abdomen, mostly due to non-surgical intestinal inflammatory pathology. However, surgical complications occur in patients with MIS-C; therefore, a high index of suspicion should remain.
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Affiliation(s)
- Glykeria Rouva
- Department of Paediatrics University General Hospital of Heraklion Heraklion Greece
| | - Eleni Vergadi
- Department of Paediatrics University General Hospital of Heraklion Heraklion Greece
- Department of Μother and Child, School of Medicine University of Crete Heraklion Greece
| | - Emmanouil Galanakis
- Department of Paediatrics University General Hospital of Heraklion Heraklion Greece
- Department of Μother and Child, School of Medicine University of Crete Heraklion Greece
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Panko K, Panko S, Panko S, Viachorka A, Zhavoronok S. Emergency diagnostic laparoscopy for multisystem inflammatory syndrome in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022; 77:102171. [PMID: 35004171 PMCID: PMC8721928 DOI: 10.1016/j.epsc.2021.102171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022] Open
Abstract
COVID-19 and multisystem inflammatory syndrome in children (MIS-C) can mimic and cause acute abdominal diseases such as intestinal obstruction, terminal ileitis, colitis, internal necrotizing mesenteric lymphadenitis, acute appendicitis, and sometimes bowel perforation. We report a case of a 6-year-old female with MIS-C and acute purulent pelviperitonitis, who was successfully treated by laparoscopy and an antibiotic without intravenous immunoglobulin and aspirin therapy. We believe that the case description should help to find a worthy place for early laparoscopic and other minimally invasive procedures for the management of similar MIS-C cases.
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Affiliation(s)
- Katsiaryna Panko
- Department of Infectious Diseases, Brest Regional Clinical Hospital, Brest, Belarus
| | - Siarhei Panko
- Department of Transplantology, Abdominal and Thoracic Surgery, Brest Regional Clinical Hospital, Brest, Belarus
| | - Sviatlana Panko
- Department of Anatomy, Physiology and Human Safety, AS Pushkin Brest State University, Brest, Belarus
| | - Andrej Viachorka
- Department of Pediatric Surgery, Brest Regional Children's Hospital, Brest, Belarus
| | - Serhey Zhavoronok
- Department of Infectious Diseases, Belarusian State Medical University, Minsk, Belarus
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11
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Fadgyas B, Garai GI, Schnur J, Kiss VI, Vass V, Mátyus E, Balázs G, Cserni T. COVID-19-Related Intestinal Ischemia in A 7-Year Old Boy. European J Pediatr Surg Rep 2022; 10:e107-e110. [PMID: 35992308 PMCID: PMC9381359 DOI: 10.1055/s-0042-1755721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 01/18/2022] [Indexed: 10/26/2022] Open
Abstract
AbstractSevere abdominal pain and vomiting are common symptoms in children with pediatric multisystem inflammatory syndrome (PIMS). Mesenteric lymphadenitis and aseptic peritonitis are predominantly reported in cases where acute surgical abdomen was suspected and laparotomy was performed at the early stage of the pandemic. These reports generally discouraged surgeons to perform exploration in COVID-19-related cases and medical management was prioritized. Only a few COVID-19-specific surgical cases with intestinal ischemia were published. Here, we report another case of COVID-19-related intestinal ischemia complicated with Meckel's diverticulitis in a non-immunocompromised child who clearly required surgical intervention. In our case, the combination of COVID-19-related vasculitis and low blood pressure episodes may have contributed to this severe outcome.
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Affiliation(s)
- Balázs Fadgyas
- Department of Surgery and Traumatology, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Gábor István Garai
- Department of Surgery and Traumatology, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - János Schnur
- Department of Anaesthesia & Intensive Care, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Viktória Irén Kiss
- Department of Anaesthesia & Intensive Care, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Viktória Vass
- Department of Pathology, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Enikő Mátyus
- Center of MRI and CT Diagnostics, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - György Balázs
- Center of MRI and CT Diagnostics, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Tamas Cserni
- Department of Pediatric Surgery, Josa Andras Hospital Nyíregyháza, Teaching Hospital of Medical Health Science Centre University of Debrecen, Nyíregyháza, Hungary
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Fabi M, Vasuri F, Guida F, Rocca A, Lima M, D'Errico A, Lanari M. Case report: Histological findings of peri-appendicitis in three children with SARS-CoV-2 - related multisystem inflammatory syndrome: A mark for systemic inflammation? Front Pediatr 2022; 10:975940. [PMID: 36467465 PMCID: PMC9714539 DOI: 10.3389/fped.2022.975940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition that can potentially develop after SARS-CoV-2 infection in children. Gastrointestinal manifestation in MIS-C can mimic acute abdomen, potentially leading to unnecessary surgical treatment. Immune-mediated mechanisms seem to be a determining factor in its pathogenesis, and histological studies can help to shed light on this aspect. We describe three cases of children diagnosed with MIS-C that underwent appendectomy. METHODS We retrospectively collected the clinical features and histological findings of three previously healthy children who underwent appendectomy for clinical suspicion of acute appendicitis but were later diagnosed with MIS-C. FINDINGS The three children presented with prominent abdominal manifestations and fever leading to the suspicion of acute abdomen. Histological findings showed transmural and perivascular inflammation. Notably, CD68+ macrophages were predominant in the child with milder abdominal symptoms without cardiac injury, while CD3+ lymphocytes in the patient presented with more severe abdominal pain and cardiovascular involvement at admission. INTERPRETATION Gastrointestinal symptoms of children with MIS-C improve after proper immunomodulatory therapy, conversely showing inadequate response to surgical appendectomy. Histological findings revealed different inflammatory cell infiltration that primarily involved perivisceral fat and vessels, and subsequently mucosal tissue, in contrast to other forms of acute appendicitis. Our findings suggest that this kind of peri-appendicitis in MIS-C could represent a focal sign of systemic inflammation, with different histological patterns compared to other forms of acute appendicitis.
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Affiliation(s)
- Marianna Fabi
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fiorentina Guida
- Speciality School of Pediatrics, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alessandro Rocca
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mario Lima
- Division of Pediatric Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonietta D'Errico
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marcello Lanari
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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13
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Unny AK, Rajashree P, Sundararajan L, Sankar J. Abdominal Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Experience. Indian Pediatr 2022; 59:936-938. [PMID: 36511208 PMCID: PMC9798947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We reviewed the cases of probable multisystem inflammatory syndrome in children (MIS-C) to identify those cases that mimicked surgical emergencies. METHODS Records of children managed for MIS-C during a 15-month period between March, 2020 and April, 2021 were retrieved. Data on clinical presentation, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR report, SARS-CoV-2 antibody status, blood investigations, radiological investigations and management were collected. RESULTS A total of 28 out of 83 children with probable MIS-C had acute abdominal symptoms and signs. Fifteen children had mild features like diffuse abdominal pain or non-bilious vomiting, and the remaining 13 (46.2%) had severe abdominal signs or bilious vomiting. Four children worsened with conservative treatment for MIS-C and were detected with perforated appendicitis. Two more children developed recurrent appendicitis on follow up. One child with appendicitis who underwent laparoscopic appendectomy, later manifested with MIS-C. CONCLUSION Surgical abdominal emergencies may be confused with or occur concurrently in children with MIS-C that should be identified with a high index of suspicion.
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Affiliation(s)
- Ashitha K. Unny
- grid.412931.c0000 0004 1767 8213Department of Pediatric Surgery, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India 600 034
| | - P Rajashree
- grid.412931.c0000 0004 1767 8213Department of Pediatrics, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
| | - Lakshmi Sundararajan
- grid.412931.c0000 0004 1767 8213Department of Pediatric Surgery, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India 600 034
| | - Janani Sankar
- Department of Pediatrics, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu. Correspondence to: Dr Ashitha K Unny, Department of Pediatric Surgery, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu 600 034.
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14
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"Inflammatory peritonitis in a child with COVID-19″. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 75:102077. [PMID: 34660197 PMCID: PMC8511549 DOI: 10.1016/j.epsc.2021.102077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is the disease caused by SARS-COV-2 coronavirus infection (Severe acute respiratory syndrome coronavirus 2). Although its most prevalent symptoms are respiratory, there are descriptions of gastrointestinal manifestations in children, but the presentation as an acute abdomen is rare. We report the case of a 6-month-old infant who was admitted with a diagnosis of intestinal obstruction and generalized peritonitis with no apparent cause, in whom a SARS-CoV-2 rt-PCR search was positive. We have not found descriptions of similar cases in the literature so far.
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15
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Yock-Corrales A, Lenzi J, Ulloa-Gutiérrez R, Gómez-Vargas J, Antúnez-Montes OY, Rios Aida JA, del Aguila O, Arteaga-Menchaca E, Campos F, Uribe F, Díaz RH, Buitrago AP, Londoño LMB, Kozicki V, Brizuela M, Buonsenso D. Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America. Pediatr Infect Dis J 2021; 40:e364-e369. [PMID: 34260501 PMCID: PMC8443421 DOI: 10.1097/inf.0000000000003240] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). METHODS Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes. FINDINGS One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant. CONCLUSIONS Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.
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Affiliation(s)
- Adriana Yock-Corrales
- From the Pediatric Emergency Department, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS, San José, Costa Rica
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Rolando Ulloa-Gutiérrez
- Infectious Disease Department, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS, San José, Costa Rica
| | - Jessica Gómez-Vargas
- From the Pediatric Emergency Department, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS, San José, Costa Rica
| | - Omar Yassef Antúnez-Montes
- Departamento de Docencia e Investigación, Instituto Latinoamericano de Ecografía en Medicina (ILEM), Ciudad de Mexico, Mexico
| | | | - Olguita del Aguila
- Department of Pediatrics, Unidad de Infectología Pediátrica del Hospital Nacional Edgardo Rebagliati Martins-Lima-Perú
| | | | - Francisco Campos
- Department of Pediatrics, Hospital Madre Niño San Bartolome, Lima, Peru
| | - Fadia Uribe
- Department of Pediatrics, Hospital Madre Niño San Bartolome, Lima, Peru
| | | | - Andrea Parra Buitrago
- Department of Pediatrics, Hospital Pablo Tobon Uribe Medellin, Colombia
- Department of Pediatrics, Fundacion Neumologica Colombiana, Bogotà, Colombia
| | | | - Verónica Kozicki
- Pediatric Infectious Disease, Hospital isidoro Iriarte, Quilmes, Buenos Aires, Argentina
| | - Martin Brizuela
- Pediatric Infectious Disease, Hospital isidoro Iriarte, Quilmes, Buenos Aires, Argentina
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Pediatrics, Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italia
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16
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Ardila Gómez IJ, López PP, Duque DC, García DMS, Romero AF, Vega MRV, Ramos Castañeda JA. Abdominal manifestation of multisystemic inflammatory syndrome in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 74:102042. [PMID: 34545321 PMCID: PMC8444470 DOI: 10.1016/j.epsc.2021.102042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/29/2022] Open
Abstract
Summary Multisystemic inflammatory syndrome (MIS-C) can develop as a complication of SARS CoV-2 infection, involving the gastrointestinal system mainly by vasoconstriction, edema, glandular hyperplasia, and a procoagulant state leading to direct tissue injury. Method ology: a series of cases including 8 patients with MIS-C treated in two highly complex institutions is presented. These patients, had abdominal symptoms of surgical management. Results The average age was 9.5 years and the most frequent symptoms were fever, abdominal pain, diarrhea (100%); in addition, 87.5% presented shock. The diagnosis of SARS CoV-2 was confirmed by RT-PCR test in 37.5%, antigen 12.5% and the rest of the patients showed IgM and IgG antibodies. In laboratories, the increase in acute phase reactants, Erythrocyte Sedimentation Rate (ESR), C-reactive protein, procalcitonin, as well as troponin, D dimer and proBNP, is highlighted. The surgical outcome documented 2 patients with a normal appendix, 3 patients with edematous appendicitis, and 3 patients with complicated appendicitis. Conclusions patients with MIS-C display abdominal symptoms similar to those present in surgical emergencies and a non-negligible number of cases require surgical exploration. This condition poses a new differential diagnosis to the surgical abdomen in pediatric patients.
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Affiliation(s)
- Iván José Ardila Gómez
- Pediatric Critical Care, Colombia.,Clínica Uros, Neiva, Huila, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Pilar Pérez López
- Pediatric Rheumatology, Colombia.,Clínica Uros, Neiva, Huila, Colombia.,Clínica Medilaser, Neiva, Huila, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Darling Carvajal Duque
- Pediatric Critical Care, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Doris Martha Salgado García
- Pediatric Bioethicist, Colombia.,Pediatric Infectious Diseases, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Andres Felipe Romero
- Pediatric Infectious Diseases, Colombia.,Clínica Uros, Neiva, Huila, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Martha Rocío Vega Vega
- Pediatric Bioethicist, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Jorge Andres Ramos Castañeda
- Professor at Universidad Surcolombiana, Neiva, Huila, Colombia.,MSc Clinical Epidemiology, PhD Public Health, Universidad Antonio Nariño, Neiva, Huila, Colombia
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17
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De Nigris A, Pepe A, Di Nardo G, Giannattasio A, Pagano A, D’Anna C, Muzzica S, Lenta S, Di Marco GM, Tipo V. Brugada Pattern in a Child with Severe SARS-CoV-2 Related Multisystem Inflammatory Syndrome. Pediatr Rep 2021; 13:504-510. [PMID: 34564341 PMCID: PMC8482132 DOI: 10.3390/pediatric13030058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/30/2022] Open
Abstract
This report presents the first case of Brugada pattern complicated by a supraventricular arrhythmia in a child with SARS-CoV-2 related Multisystem Inflammatory Syndrome in Children (MIS-C). A 7-year-old boy came to our Emergency Department with 7 days of abdominal pain and fever. MIS-C was diagnosed on the basis of the clinical, laboratory and instrumental tests. On admission, ECG showed type 1 Brugada pattern in the right precordial leads. During hospitalization the onset of supraventricular arrhythmias complicated the clinical picture. This case underlines management complexity of supraventricular arrhythmic events, different from atrial fibrillation, in patients with Brugada pattern in the context of a systemic inflammatory condition with significant cardiac involvement. All potential therapeutic choices should be considered to ensure the best outcomes.
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Affiliation(s)
- Angelica De Nigris
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Angela Pepe
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Pediatrics Section, University of Salerno, 84081 Baronissi, Italy;
| | - Giangiacomo Di Nardo
- Division of Cardiology, Department of Pediatrics, Santobono-Pausilipon Children Medical Hospital, 80129 Naples, Italy; (G.D.N.); (G.M.D.M.)
| | - Antonietta Giannattasio
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (A.G.); (C.D.); (S.M.); (S.L.); (V.T.)
| | - Annamaria Pagano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80126 Naples, Italy;
| | - Carolina D’Anna
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (A.G.); (C.D.); (S.M.); (S.L.); (V.T.)
| | - Stefania Muzzica
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (A.G.); (C.D.); (S.M.); (S.L.); (V.T.)
| | - Selvaggia Lenta
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (A.G.); (C.D.); (S.M.); (S.L.); (V.T.)
| | - Giovanni Maria Di Marco
- Division of Cardiology, Department of Pediatrics, Santobono-Pausilipon Children Medical Hospital, 80129 Naples, Italy; (G.D.N.); (G.M.D.M.)
| | - Vincenzo Tipo
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (A.G.); (C.D.); (S.M.); (S.L.); (V.T.)
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18
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Manz N, Höfele-Behrendt C, Bielicki J, Schmid H, Matter MS, Bielicki I, Holland-Cunz S, Gros SJ. MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations. CHILDREN (BASEL, SWITZERLAND) 2021; 8:712. [PMID: 34438603 PMCID: PMC8393765 DOI: 10.3390/children8080712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND multisystem inflammatory syndrome in children (MIS-C) is a new disease associated with a recent infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Affected children can present predominantly with abdominal symptoms, fever and high inflammatory parameters that might lead to a consult by the pediatric surgeon and an indication for surgery. METHODS clinical data of three patients with MIS-C that underwent surgery were collected. Histopathological analysis of the appendix was performed. RESULTS we present the clinical course of three children with fever, abdominal pain and vomiting for several days. Clinical examination and highly elevated inflammation markers led to indication for laparoscopy; appendectomy was performed in two patients. Because of intraoperative findings or due to lack of postoperative improvement, all patients were reevaluated and tested positive for MIS-C associated laboratory parameters and were subsequently treated with corticosteroids, intravenous immunoglobulins, acetyl salicylic acid and/or light molecular weight heparin. CONCLUSIONS we discuss the implications of MIS-C as a new differential diagnosis and stress the importance of assessing the previous medical history, identifying patterns of symptoms and critically surveilling the clinical course. We implemented an algorithm for pediatric surgeons to consider MIS-C as a differential diagnosis for acute abdomen that can be integrated into the surgical workflow.
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Affiliation(s)
- Nora Manz
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4056 Basel, Switzerland; (N.M.); (C.H.-B.); (I.B.); (S.H.-C.)
- Department of Clinical Research, University of Basel, 4056 Basel, Switzerland
| | - Claudia Höfele-Behrendt
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4056 Basel, Switzerland; (N.M.); (C.H.-B.); (I.B.); (S.H.-C.)
| | - Julia Bielicki
- Department of Infectious Diseases, University Children’s Hospital Basel, 4056 Basel, Switzerland; (J.B.); (H.S.)
| | - Hanna Schmid
- Department of Infectious Diseases, University Children’s Hospital Basel, 4056 Basel, Switzerland; (J.B.); (H.S.)
| | - Matthias S. Matter
- Institute of Medical Genetics and Pathology, University Hospital of Basel, University of Basel, 4031 Basel, Switzerland;
| | - Isabella Bielicki
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4056 Basel, Switzerland; (N.M.); (C.H.-B.); (I.B.); (S.H.-C.)
- Department of Clinical Research, University of Basel, 4056 Basel, Switzerland
| | - Stefan Holland-Cunz
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4056 Basel, Switzerland; (N.M.); (C.H.-B.); (I.B.); (S.H.-C.)
- Department of Clinical Research, University of Basel, 4056 Basel, Switzerland
| | - Stephanie J. Gros
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4056 Basel, Switzerland; (N.M.); (C.H.-B.); (I.B.); (S.H.-C.)
- Department of Clinical Research, University of Basel, 4056 Basel, Switzerland
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19
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Jurkiewicz B, Szymanek-Szwed M, Hartmann P, Samotyjek J, Brędowska E, Kaczorowska J, Wajszczuk E, Twardowska-Merecka M, Cybulska J. Pediatric Multisystem Inflammatory Syndrome in Children as a Challenging Problem for Pediatric Surgeons in the COVID 19 Pandemic-A Case Report. Front Pediatr 2021; 9:677822. [PMID: 34178893 PMCID: PMC8225948 DOI: 10.3389/fped.2021.677822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 01/29/2023] Open
Abstract
The first cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were identified at the end of 2019 and, in the next few months, coronavirus disease (COVID-19) spread throughout the world. Initially, it was believed that this disease mainly affected elderly individuals with comorbidities, in whom respiratory failure often occurs. It was believed that children fell ill from the infection more often, although the course of infection in the vast majority of pediatric cases has been asymptomatic or mildly symptomatic. In April and May 2020, the first report of a rapidly progressing disease, similar to Kawasaki syndrome, was found in children who had been infected with SARS-CoV-2. Shortly thereafter, children with symptoms of pediatric inflammatory multisystem syndrome (PIMS-ST [temporally associated with SARS-CoV-2 infection]) began presenting to pediatric hospitals around the world. The syndrome has a mortality rate of up to 2%. Symptoms of PIMS-TS include those that may suggest the need for surgical treatment (severe abdominal pain with the presence of peritoneal symptoms, ascites, high levels of inflammatory markers, intestinal inflammation, and appendages revealed on ultrasound examination). However, there are few reports addressing surgical cases associated with this condition. The authors present a case involving an 11-year-old boy who was admitted to hospital with severe abdominal pain and underwent surgery for symptoms of peritonitis and was diagnosed with PIMS in the post-operative period. Due to the large number of illnesses caused by SARS-CoV-2 infection in recent months, the diagnosis of PIMS-TS/MISC should be considered in the differential diagnosis of acute abdominal symptoms, especially in atypical courses and interviews indicating exposure to SARS-CoV-2.
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Affiliation(s)
- Beata Jurkiewicz
- Department of Pediatric Surgery and Pediatric Urology, Medical Center of Postgraduate Education, Dziekanów Leśny, Poland
| | - Magdalena Szymanek-Szwed
- Department of Pediatric Surgery and Pediatric Urology, Medical Center of Postgraduate Education, Dziekanów Leśny, Poland
| | - Piotr Hartmann
- Department of Pediatrics, Children's Hospital, Dziekanów Leśny, Poland
| | - Joanna Samotyjek
- Department of Pediatric Surgery and Pediatric Urology, Medical Center of Postgraduate Education, Dziekanów Leśny, Poland
| | - Eliza Brędowska
- Department of Pediatrics, Children's Hospital, Dziekanów Leśny, Poland
| | | | - Ewa Wajszczuk
- Department of Pediatric Surgery and Pediatric Urology, Medical Center of Postgraduate Education, Dziekanów Leśny, Poland
| | - Martyna Twardowska-Merecka
- Department of Pediatric Surgery and Pediatric Urology, Medical Center of Postgraduate Education, Dziekanów Leśny, Poland
| | - Joanna Cybulska
- Department of Pediatric Surgery and Pediatric Urology, Medical Center of Postgraduate Education, Dziekanów Leśny, Poland
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