Acute abdomen, appendicitis may occur in children with COVID-19, MIS-C

Paediatric patients with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) may develop acute abdomen, with or without appendicitis, a study in Latin America has found.

“Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C,” the researchers said.

The study enrolled 1,010 children aged ≤17 years evaluated in five Latin American countries with a diagnosis of microbiologically confirmed SARS-CoV-2 infection and children fulfilling MIS-C definition. For those with acute abdomen, the researchers examined main radiologic patterns, surgical treatment, and intraoperative findings.

Of the participants, 42 (4.2 percent) were diagnosed with acute abdomen and four (9.5 percent) with MIS-C but did not undergo surgery. Thirty-eight children (3.8 percent) underwent abdominal surgery due to suspected appendicitis, of whom 34 (89.7 percent) had an intraoperative diagnosis of acute appendicitis (AA), while four had nonsurgical findings. [Pediatr Infect Dis J 2021;40:e364-e369]

Unfortunately, eight children died (0.8 percent), none of whom had a diagnosis of appendicitis. Children with AA were significantly older that those without AA (p<0.0001).

Additionally, children with vs without complicated appendicitis were more likely to have fever (85.7 percent vs 60 percent), intestinal distension on the abdominal radiograph (7.1 percent vs none), leukocytosis (85.7 percent vs 40 percent), and high levels of C-reactive protein (35.7 percent vs 5 percent). However, the differences were not statistically significant.

Earlier studies have reported case series of paediatric patients with AA during COVID-19 and MIS-C, which characterize the association between this infection and delays in diagnosis and treatment. [Pediatr Infect Dis J 2020;39:e472-e473; J Pediatr Surg Case Rep 2021;69:101838; Pediatr Emerg Care 2021;37:185-190]

“In our study, we found a low prevalence of diagnosis of AA but higher than other reported series,” the researchers said. “Gastrointestinal symptoms were present in a third of all COVID-19 patients and present in all patients with the diagnosis of AA.” [Lancet Child Adolesc Health 2020;4:e19-e20]

Of note, delays in the approach and management of AA patients could increase the risk of perforation and complications leading to longer length of stay. [Acta Paediatr 2020;109:1672-1676]

“However, we did not find that a delay in the diagnosis of appendicitis in these patients was associated with a higher incidence of complications (41.1 percent),” the researchers said.

The current study was limited by the small number of patients with AA and COVID-19 and the absence of data for the time from diagnosis and the surgical management. Despite these limitations, the findings provided the largest overview of AA in children with COVID-19 and MIS-C to date.

“Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions, and [to] minimize unnecessary surgical approaches,” the researchers said.