Cargando…

Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital

INTRODUCTION: and importance: A common gastrointestinal presentation of both COVID-19 and multisystem inflammatory syndrome in children (MIS-C) is acute abdominal pain, which sometimes mimics appendicitis. Literature describing children with COVID-19 infection and concurrent acute appendicitis is gr...

Descripción completa

Detalles Bibliográficos
Autores principales: Nurnaningsih, Danudibroto, Gladys Indika, Rusmawatiningtyas, Desy, Kumara, Intan Fatah, Makrufardi, Firdian, Widowati, Titis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8789554/
https://www.ncbi.nlm.nih.gov/pubmed/35096389
http://dx.doi.org/10.1016/j.amsu.2022.103315
_version_ 1784639793573920768
author Nurnaningsih
Danudibroto, Gladys Indika
Rusmawatiningtyas, Desy
Kumara, Intan Fatah
Makrufardi, Firdian
Widowati, Titis
author_facet Nurnaningsih
Danudibroto, Gladys Indika
Rusmawatiningtyas, Desy
Kumara, Intan Fatah
Makrufardi, Firdian
Widowati, Titis
author_sort Nurnaningsih
collection PubMed
description INTRODUCTION: and importance: A common gastrointestinal presentation of both COVID-19 and multisystem inflammatory syndrome in children (MIS-C) is acute abdominal pain, which sometimes mimics appendicitis. Literature describing children with COVID-19 infection and concurrent acute appendicitis is growing, and understanding these patients’ clinical picture is necessary for their proper treatment. CASE PRESENTATION: We present a case series of six healthy children before they developed classic symptoms of appendicitis. At the same time, they were also found to have confirmed COVID-19. All patients had fever and right lower abdominal pain. Four of six children having Alvarado score above seven had surgical treatment, while the others only received systemic antibiotic and antiviral medication. Surgical results of two patients revealed perforated appendicitis. No mortality occurred among them. CLINICAL DISCUSSION: There is increasing recognition of gastrointestinal involvement in patients with COVID-19 and MIS-C. There are several postulates to explain appendicitis in COVID-19. First, inflammatory response is exaggerated in SARS-CoV-2 infected patients. Second, obstruction of the appendiceal lumen is caused by mesenteric adenopathy, which in turn, is caused by COVID-19 infection, not fecalith. Third, hyperinflammatory response in MIS-C triggers inflammation in appendix. CONCLUSION: Clinicians must recognize that abdominal pain with fever could be the presenting symptoms of COVID-19 with MIS-C. MIS-C, which has severe presentations with gastrointestinal manifestations and high mortality rate, should be considered as a differential diagnosis for a patient with appendicitis-like symptoms and a positive SARS-CoV-2 infection.
format Online
Article
Text
id pubmed-8789554
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-87895542022-01-26 Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital Nurnaningsih Danudibroto, Gladys Indika Rusmawatiningtyas, Desy Kumara, Intan Fatah Makrufardi, Firdian Widowati, Titis Ann Med Surg (Lond) Case Series INTRODUCTION: and importance: A common gastrointestinal presentation of both COVID-19 and multisystem inflammatory syndrome in children (MIS-C) is acute abdominal pain, which sometimes mimics appendicitis. Literature describing children with COVID-19 infection and concurrent acute appendicitis is growing, and understanding these patients’ clinical picture is necessary for their proper treatment. CASE PRESENTATION: We present a case series of six healthy children before they developed classic symptoms of appendicitis. At the same time, they were also found to have confirmed COVID-19. All patients had fever and right lower abdominal pain. Four of six children having Alvarado score above seven had surgical treatment, while the others only received systemic antibiotic and antiviral medication. Surgical results of two patients revealed perforated appendicitis. No mortality occurred among them. CLINICAL DISCUSSION: There is increasing recognition of gastrointestinal involvement in patients with COVID-19 and MIS-C. There are several postulates to explain appendicitis in COVID-19. First, inflammatory response is exaggerated in SARS-CoV-2 infected patients. Second, obstruction of the appendiceal lumen is caused by mesenteric adenopathy, which in turn, is caused by COVID-19 infection, not fecalith. Third, hyperinflammatory response in MIS-C triggers inflammation in appendix. CONCLUSION: Clinicians must recognize that abdominal pain with fever could be the presenting symptoms of COVID-19 with MIS-C. MIS-C, which has severe presentations with gastrointestinal manifestations and high mortality rate, should be considered as a differential diagnosis for a patient with appendicitis-like symptoms and a positive SARS-CoV-2 infection. Elsevier 2022-01-26 /pmc/articles/PMC8789554/ /pubmed/35096389 http://dx.doi.org/10.1016/j.amsu.2022.103315 Text en © 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Series
Nurnaningsih
Danudibroto, Gladys Indika
Rusmawatiningtyas, Desy
Kumara, Intan Fatah
Makrufardi, Firdian
Widowati, Titis
Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital
title Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital
title_full Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital
title_fullStr Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital
title_full_unstemmed Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital
title_short Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital
title_sort acute appendicitis in pediatric patients with coronavirus disease 2019 (covid-19): a case series from a developing country's tertiary hospital
topic Case Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8789554/
https://www.ncbi.nlm.nih.gov/pubmed/35096389
http://dx.doi.org/10.1016/j.amsu.2022.103315
work_keys_str_mv AT nurnaningsih acuteappendicitisinpediatricpatientswithcoronavirusdisease2019covid19acaseseriesfromadevelopingcountrystertiaryhospital
AT danudibrotogladysindika acuteappendicitisinpediatricpatientswithcoronavirusdisease2019covid19acaseseriesfromadevelopingcountrystertiaryhospital
AT rusmawatiningtyasdesy acuteappendicitisinpediatricpatientswithcoronavirusdisease2019covid19acaseseriesfromadevelopingcountrystertiaryhospital
AT kumaraintanfatah acuteappendicitisinpediatricpatientswithcoronavirusdisease2019covid19acaseseriesfromadevelopingcountrystertiaryhospital
AT makrufardifirdian acuteappendicitisinpediatricpatientswithcoronavirusdisease2019covid19acaseseriesfromadevelopingcountrystertiaryhospital
AT widowatititis acuteappendicitisinpediatricpatientswithcoronavirusdisease2019covid19acaseseriesfromadevelopingcountrystertiaryhospital