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Kono J, Yoshimaru K, Matsuura T, Tamaki A, Takemoto J, Matsumoto S, Hotta T, Kohashi K, Oda Y, Tajiri T. COVID19 detection in appendix of acute appendicitis in a child: a case report and review of literature. Surg Case Rep 2023; 9:37. [PMID: 36917284 PMCID: PMC10012291 DOI: 10.1186/s40792-023-01618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Gastrointestinal symptoms are one of the most common presentations of Coronavirus disease-19 (COVID-19), even in children. Higher rates of complicated appendicitis have been demonstrated in the era of the COVID-19 outbreak, and it has been recently suggested that acute appendicitis may occur as a complication of COVID-19. However, the relationship between appendicitis and COVID-19 remains unclear. CASE PRESENTATION A 7-year-old male presented to the pediatric emergency department with 2 days' history of lower abdominal discomfort and tenderness. On examination, his abdomen was distended with diffuse mild tenderness at the lower abdomen, which was aggravated by movement. He was also tested and was found to be positive for SARS-CoV-2. Computed tomography showed perforated appendicitis with a fecalith. The patient was admitted and laparoscopic appendectomy was successfully performed. Postoperatively, a minor intra-abdominal abscess was present, which successfully treated with antibiotics. Histopathology showed a markedly inflamed appendix with mucosal ulceration and transmural neutrophilic inflammation, which was consistent with phlegmonous appendicitis. Reverse transcription quantitative polymerase chain reaction using a surgically extracted appendix specimen revealed the presence of SARS-CoV-2 virus, which indicated a pathophysiological relationship between appendicitis and COVID-19. CONCLUSION The present case will provide further understanding of pediatric patients with concomitant COVID-19 and acute appendicitis.
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Affiliation(s)
- Jun Kono
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koichiro Yoshimaru
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Akihiko Tamaki
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Junkichi Takemoto
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.,Division of Pediatric Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Shinya Matsumoto
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Taeko Hotta
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital. Ann Med Surg (Lond) 2022; 74:103315. [PMID: 35096389 PMCID: PMC8789554 DOI: 10.1016/j.amsu.2022.103315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022] Open
Abstract
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. Inflammatory response is exaggerated in SARS-CoV-2 infected patients. Obstruction of the appendiceal lumen is caused by mesenteric adenopathy. Hyperinflammatory response in MIS-C triggers inflammation in appendix.
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Sener Okur D, Memetoglu ME, Edirne Y. Impact of the COVID-19 pandemic and the restrictions on pediatric appendicitis in Turkey: A single-center experience. Pediatr Int 2022; 64:e15272. [PMID: 36074063 PMCID: PMC9349503 DOI: 10.1111/ped.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study we investigated how the incidence and course of acute appendicitis (AA) changed in children during the pandemic. METHODS Children diagnosed with AA during the 1-year pandemic period after the first COVID-19 case in Turkey and the previous 1 year were included in the study. Children were divided into two groups: those hospitalized during the pandemic (group A) and those hospitalized in the year before the pandemic (group B). Furthermore, we compared the findings obtained for COVID-19-positive and COVID-19-negative children in the whole study group and within group A. RESULTS A significant difference was found between the two groups in terms of gender, the rate of vomiting and the number of days of vomiting. Complicated AA was more frequent in group B than in group A. In addition, the hospital stay was significantly longer, the mean number of days with fever was significantly higher, and mean body temperature was significantly higher in COVID-19-positive patients in the whole study group and within group A. CONCLUSIONS Contrary to most studies in the literature, in the present study the patients in the pre-pandemic period were admitted to hospital later, and this may have been associated with the higher frequency of complicated AA in these patients. During the pandemic, however, the arrangements and warnings of health authorities might have reduced the anxiety and the hesitancy of families to go to the hospital, and hence this may have been associated with the lower rate of complicated AA in this period.
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Affiliation(s)
- Dicle Sener Okur
- Division of Pediatric Infectious Diseases, Department of Pediatrics, State Hospital of Denizli, Denizli, Turkey
| | | | - Yesim Edirne
- Department of Pediatric Surgery, State Hospital of Denizli, Denizli, Turkey
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