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Children with COVID-19 or MIS-C May Develop Acute Abdomen Appendicitis

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.

Children with COVID-19 or MIS-C May Develop Acute Abdomen 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.

“More study is needed to better describe children with acute abdomen during COVID-19 or MIS-C, to avoid delays in surgical diagnosis, and [to] minimize unnecessary surgical approaches,” the researchers concluded.
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