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Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from
Adriana Yock-Corrales1, Jacopo Lenzi2, Rolando Ulloa-Gutiérrez3
1From the Pediatric Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica.
Insights
Children with COVID-19 or MIS-C can experience acute abdomen, but appendicitis is not always confirmed during surgery, especially in MIS-C cases. Further research is needed to improve diagnosis and surgical decisions.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
- Infectious Diseases
Background:
- Sporadic reports exist of acute abdomen and appendicitis in children with COVID-19 and MIS-C.
- This study addresses the limited understanding of gastrointestinal manifestations in pediatric COVID-19 and MIS-C.
Purpose of the Study:
- To investigate the presentation, surgical findings, and outcomes of acute abdomen in children with COVID-19 and MIS-C.
- To differentiate between appendicitis and other causes of acute abdomen in this population.
Main Methods:
- Retrospective analysis of 1010 children diagnosed with SARS-CoV-2 infection or MIS-C across 5 Latin American countries.
- Detailed review of radiologic patterns, surgical treatments, and intraoperative findings for children presenting with acute abdomen.
Main Results:
- 4.2% of children (42/1010) presented with acute abdomen; 3.8% (38/1010) underwent surgery for suspected appendicitis.
- Of those operated, 89.7% (34/38) had confirmed acute appendicitis; 4 had non-surgical findings.
- Children with appendicitis were older; complicated appendicitis showed trends towards fever, radiographic findings, and elevated inflammatory markers, though not statistically significant.
Conclusions:
- Acute abdomen in children with COVID-19 or MIS-C can occur, but surgical findings of appendicitis are not consistently present, particularly in MIS-C.
- Further research is crucial to accurately diagnose surgical conditions and avoid unnecessary surgeries in children with COVID-19 and MIS-C.
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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