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MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations

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 th...

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Autores principales: Manz, Nora, Höfele-Behrendt, Claudia, Bielicki, Julia, Schmid, Hanna, Matter, Matthias S., Bielicki, Isabella, Holland-Cunz, Stefan, Gros, Stephanie J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393765/
https://www.ncbi.nlm.nih.gov/pubmed/34438603
http://dx.doi.org/10.3390/children8080712
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author Manz, Nora
Höfele-Behrendt, Claudia
Bielicki, Julia
Schmid, Hanna
Matter, Matthias S.
Bielicki, Isabella
Holland-Cunz, Stefan
Gros, Stephanie J.
author_facet Manz, Nora
Höfele-Behrendt, Claudia
Bielicki, Julia
Schmid, Hanna
Matter, Matthias S.
Bielicki, Isabella
Holland-Cunz, Stefan
Gros, Stephanie J.
author_sort Manz, Nora
collection PubMed
description 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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spelling pubmed-83937652021-08-28 MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations Manz, Nora Höfele-Behrendt, Claudia Bielicki, Julia Schmid, Hanna Matter, Matthias S. Bielicki, Isabella Holland-Cunz, Stefan Gros, Stephanie J. Children (Basel) Article 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. MDPI 2021-08-19 /pmc/articles/PMC8393765/ /pubmed/34438603 http://dx.doi.org/10.3390/children8080712 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Manz, Nora
Höfele-Behrendt, Claudia
Bielicki, Julia
Schmid, Hanna
Matter, Matthias S.
Bielicki, Isabella
Holland-Cunz, Stefan
Gros, Stephanie J.
MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations
title MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations
title_full MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations
title_fullStr MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations
title_full_unstemmed MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations
title_short MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations
title_sort mis-c-implications for the pediatric surgeon: an algorithm for differential diagnostic considerations
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393765/
https://www.ncbi.nlm.nih.gov/pubmed/34438603
http://dx.doi.org/10.3390/children8080712
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