A study in Latin America discovered that pediatric patients with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) can develop acute abdomen with or without appendicitis.
 |
| Photo: Child with COVID-19 | InStyleHealth |
“Our data demonstrate that children may report with
acute abdomen during COVID-19 or MIS-C, which is not necessarily accompanied
with intraoperative appendicitis findings, particularly in the case of MIS-C,”
the researchers said.
The study included 1,010 children aged 17 years old
who were assessed in five Latin American nations and had a microbiologically
proven SARS-CoV-2 infection as well as children who met the MIS-C criteria. The
researchers looked at the primary radiologic patterns, surgical treatment, and
intraoperative results in those who had an acute abdomen.
Forty-two (4.2%) of the patients were diagnosed with acute
abdomen, and four (9.5%) with MIS-C, but neither had surgery. Thirty-eight
children (3.8%) had abdominal surgery for suspected appendicitis, with 34
(89.7%) receiving an intraoperative diagnosis of acute appendicitis (AA) and
four receiving nonsurgical findings. [Pediatric Infectious Diseases Journal,
2021;40:e364-e369]
Regrettably, eight children (0.8 percent) died, none
of whom had an appendicitis diagnosis. The children who had AA were
substantially older than those who did not have AA (p0.0001).
Furthermore, children with severe appendicitis were
more likely to exhibit fever (85.7 percent vs. 60 percent), intestinal
distension on an abdominal radiograph (7.1 percent vs. none), leukocytosis
(85.7 percent vs. 40 percent), and high C-reactive protein levels (85.7 percent
vs. 40 percent) (35.7 percent vs 5 percent). Statistically, the differences
were not significant.
Case series of pediatric patients with AA during
COVID-19 and MIS-C have been reported in previous investigations, which
characterize the link between this infection and diagnostic and treatment
delays. [J Pediatr Surg Case Rep 2021;69:101838; Pediatr Emerg Care
2021;37:185-190; Pediatr Infect Dis J 2020;39:e472-e473; J Pediatr Surg Case
Rep 2021;69:101838]
“We identified a modest prevalence of AA diagnosis in
our sample, but it was greater than other reported series,” the researchers
wrote. “Gastrointestinal symptoms were present in a third of all COVID-19
patients and in all patients with the diagnosis of AA,” the researchers said.
[Lancet Child Adolesc Health 2020;4:e19-e20] [Lancet Child Adolesc Health
2020;4:e19-e20]
Delays in approaching and managing AA patients may
increase the chance of perforation and complications, resulting in a lengthier
stay. [Acta Paediatrica, 109:1672-1676, 2020]
“However, we found no evidence that a delay in
appendicitis diagnosis was related with a higher incidence of complications
(41.1 percent) in these patients,” the researchers added.
The current investigation was hampered by the small
number of patients with AA and COVID-19, as well as the lack of data on the
time between diagnosis and surgical treatment. Despite these limitations, the
data presented the most comprehensive picture of AA in COVID-19 and MIS-C
children to date.