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MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations
Nora Manz1,2, Claudia Höfele-Behrendt1, Julia Bielicki3
1Department of Pediatric Surgery, University Children's Hospital Basel, 4056 Basel, Switzerland.
Insights
Multisystem inflammatory syndrome in children (MIS-C), a condition linked to SARS-CoV-2, can mimic surgical emergencies. Early recognition and surgical consideration are crucial for timely diagnosis and treatment of MIS-C.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Pediatric Critical Care
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a novel disease associated with SARS-CoV-2 infection.
- MIS-C can present with abdominal symptoms, fever, and elevated inflammatory markers, mimicking surgical conditions.
Purpose of the Study:
- To highlight MIS-C as a critical differential diagnosis in pediatric surgical emergencies.
- To emphasize the importance of clinical history and surveillance in diagnosing MIS-C.
Main Methods:
- Retrospective review of clinical data from three pediatric patients with MIS-C who underwent surgery.
- Histopathological analysis of appendiceal specimens.
Main Results:
- Three children presented with fever, abdominal pain, and vomiting, leading to surgical intervention (appendectomy in two).
- All patients were diagnosed with MIS-C postoperatively and treated with immunomodulatory and anticoagulant therapies.
Conclusions:
- MIS-C should be considered in the differential diagnosis of acute abdomen in children.
- An algorithm is proposed for pediatric surgeons to integrate MIS-C evaluation into their workflow.
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.
