Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America.

BACKGROUND: To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). METHODS: Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes. FINDINGS: One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant. CONCLUSIONS: 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. 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 at the same time, minimize unnecessary surgical approaches.

COVID-19 Presenting as Acute Necrotizing Pancreatitis.

The ongoing pandemic of the novel coronavirus disease 2019 (COVID-19) originated in Wuhan, China, in December 2019. Various manifestations of coronavirus (SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2]) have been reported since the pandemic began. Some articles have reported acute pancreatitis in several patients due to COVID-19 infection. In this case report, we introduce a patient in whom SARS-CoV-2 caused necrotizing pancreatitis. Acute abdomen is one of the manifestations of COVID-19. Various causes such as acute pancreatitis and necrotizing pancreatitis can be in the list of differential diagnoses.

Acute surgical-like abdomen as a gastrointestinal manifestation of COVID-19 infection: a case report in Colombia.

BACKGROUND: The SARS-CoV-2 pandemic is a considerable public health problem, which has caused a burden on health systems in many countries. Despite the existence of multiple studies on the different digestive symptoms and their relationship with this disease, it is still vital to highlight the severity of the different symptoms, the need to diagnose it properly and quickly. Currently in Colombia there are no writings that highlight the above. CASE PRESENTATION: This article reports the case of a 37-year-old female patient, with no important history, who consulted for 10 h of a generalized intense abdominal pain, of sudden onset, associated with multiple stools of diarrheal consistency, and no respiratory symptoms and no epidemiological exposure. Physical examination with intense pain in the colic frame with tenderness. It was decided to rule out surgical pathology and a CT scan was performed finding no evidence of acute intra-abdominal pathology, but with a peripheral alveolar, and ground-glass opacities at lung bases, classic COVID-19 radiological pattern, confirmed by a positive RT-PCR for SARS-CoV-2, leading to consider that the gastrointestinal symptoms were secondary to this infection. Symptomatic management was given with subsequent improvement. CONCLUSIONS: It is extremely important to present this first case report of a young female COVID-19 patient with an acute abdominal pain as the main clinical manifestation, that almost culminates in a surgical procedure; demonstrating the scope of gastrointestinal symptoms secondary to SARS-CoV-2 infection.

Acute abdomen in COVID-19 disease: the pediatric surgeon's standpoint. / Abdomen agudo en la enfermedad COVID-19. El punto de vista del cirujano pediátrico.

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.

OBJETIVOS: Describir nuestra experiencia en el manejo diagnóstico y terapéutico de los pacientes que han presentado abdomen agudo como principal manifestación de la infección por SARS-Cov-2. MATERIAL Y METODOS: Estudio descriptivo de los pacientes ingresados con clínica inicial de abdomen agudo que fueron diagnosticados de COVID-19 entre el 1 de abril y el 10 de mayo de 2020. Se ha realizado la revisión de historias clínicas para la recogida de datos. RESULTADOS: Describimos una serie de 14 pacientes (9 varones y 5 mujeres) con una mediana de edad de 9,5 años. Todos ellos consultaron por dolor abdominal acompañado de fiebre en 11 y vómitos o diarrea en 9, y la sospecha clínica inicial fue de patología quirúrgica (apendicitis aguda o peritonitis) en 9. En la analítica sanguínea se encontró como característica común elevación de reactantes de fase aguda y alteraciones de coagulación. Se realizó ecografía abdominal a todos los pacientes y tomografía computarizada en cuatro observándose signos inflamatorios en íleon terminal, válvula ileocecal, colon ascendente y edema de vesícula biliar. Se optó por un manejo conservador en todos los pacientes menos uno y ocho pacientes precisaron ingreso en cuidados intensivos para tratamiento de soporte. CONCLUSIONES: La infección por el nuevo coronavirus puede producir síntomas gastrointestinales como principal manifestación, simulando un abdomen agudo que en algunos casos puede evolucionar de forma desfavorable. Para el diagnóstico es preciso realizar una buena historia clínica y exploración física, así como pruebas complementarias en busca de hallazgos característicos de COVID-19.

Severe acute hepatitis E infection presenting with acute abdomen and meningoencephalitis.

We present a case of a 50-year-old man admitted due to acute abdomen, icterus and fever. The patient had a history of sufficiently treated type 2 diabetes and a high daily alcohol consumption, no recent travel history and had a strictly heterosexual and monogamous way of living. A full blood count displayed severe elevated liver enzymes. A CT of the abdomen was performed and revealed steatosis but no acute abdominal pathology. During admission, the patient developed signs of meningoencephalitis. A lumbar puncture was performed, and the cerebrospinal fluid revealed lymphocytic pleocytosis consistent with mild inflammation. Furthermore, hepatitis E was found in the blood and the definitive diagnosis was established. The patient gradually recovered and was discharged within 8 days of admission. To the best of our knowledge, we present the second case describing concomitant hepatitis and meningoencephalitis, resolving spontaneously and not giving rise to sequelae.

Enteritis and Severe Abdominal Pain as the First Presentation of Covid-19.

Presentation A male patient with no significant past medical history presented to emergency department with progressive in severity abdominal pain, associated with mild nausea and diarrhea. No other significant symptoms were reported. Diagnosis On investigation with CT, duodenojejunitis was diagnosed as the cause of abdominal pain. Lung basal changes were also visualized and subsequently proven to be secondary to Covid-19 infection. Treatment After few days of hospitalization and supportive treatment, the patient improved clinically and was discharged. Conclusion Covid-19 infection typically presents with respiratory symptoms associated with fever and myalgia. Anorexia, diarrhea and nausea have been reported. Severe abdominal pain is rare, particularly as the initial presenting compliant. It is important to be aware of the varied clinical presentations that may occur in Covid-19, including isolated gastrointestinal symptoms. This will allow to increase the timely detectability of infected patients and more effective contact control measures.

Acute abdomen in patients with SARS-CoV-2 infection or co-infection.

PURPOSE: Patients with an acute abdomen require emergency surgery. SARS-CoV-2 infection can affect multiple organ systems, including the digestive tract. Little is known about the consequences of COVID-19 infection in emergency surgical patients. METHODS: Perioperative data for COVID-19 patients undergoing emergency surgery from March 1, 2020, to May 23, 2020 were collected prospectively (NCT04323644). RESULTS: During this period, 215 patients underwent surgery, including 127 patients in an emergency setting, of whom 13 (10.2%) had COVID-19. Two scenarios were identified: (a) patients who were admitted to a hospital for an acute surgical condition with a concomitant diagnosis of COVID-19, and (b) patients with severe COVID-19 developing acute abdominal pathologies during their hospital stay. When compared with those in group B, patients in group A globally recovered better, with a lower mortality rate (14.3% vs. 33.3%), lower ARDS rate (28.5% vs. 50.0%), less rates of preoperative invasive ventilation (14.3% vs. 50.0%) and postoperative invasive ventilation (28.5% vs. 100.0%), and a shorter duration of invasive ventilation. No causality between SARS-CoV-2 infection and gastrointestinal affliction was found. CONCLUSION: Our observations underline that mild co-infection with COVID-19 did not result in more complications for emergency abdominal surgery. Howe, an acute abdomen during severe COVID-19 infection was part of an unfavorable prognosis.

Case Report: COVID-19 Masquerading as an Acute Surgical Abdomen.

SARS-CoV-2 infection can present with various clinical features, among which gastrointestinal manifestations such as nausea, diarrhea, vomiting, and mild abdominal pain have been reported. Recognition of rare presentations of SARS-CoV-2 infection has increased over time. These atypical and rare presentations may lead to difficulties in establishing the diagnosis in a timely manner; furthermore, they may lead to unnecessary investigations, extended hospital stays, adverse outcomes, and more strain on healthcare resources. We present three cases admitted to our hospital with a picture that mimicked an acute abdomen, necessitating surgical assessment and evaluation. All cases turned out to be SARS-CoV-2 positive and did not require surgical management. We discuss the management course, highlight the importance of abdominal symptoms in the setting of COVID-19, and discuss the implications of this association for medical practice amid the current pandemic in both resource-rich and resource-limited settings.

Acute appendicitis in a child with swine influenza (H1N1).

Swine flu is a multisystemic disease and can affect the gastrointestinal system. There are only three published reports of swine flu cases with acute appendicitis; two of them in children under 16 years of age. We present an unusual case of acute appendicitis in a child already diagnosed with swine flu infection. A 9½-year-old girl presented with febrile illness and mild abdominal pain. PCR (+) was positive for H1N1. 3 days after hospital admission she developed acute appendicitis and was operated on. On the fourth postoperative day she developed right upper lobe atelectasis; she was started on antiviral treatment to which she responded very well. She was discharged on day 7 without further consequences in her postoperative course. Children with swine flu may be susceptible to rapidly deteriorating and complicated acute appendicitis. This calls for more caution especially in periods of epidemics.

[Herpes simplex can cause acute abdomen]. / Herpes simplex kan medføre akut abdomen.

In rare cases herpes simplex virus (HSV) can cause disseminated and severe disease, especially in immunoincompetent patients. An apparently immunocompetent 27-year-old woman presented to a gynaecological ward with one week of unexplained abdominal pain. After some days of observation and tests, she underwent a diagnostic laparoscopy. Vesicular elements were seen on the bladder wall, and biopsies showed HSV type 2.

Frequency, pattern and management of acute abdomen in dengue fever in Karachi, Pakistan.

OBJECTIVE: This study aimed to determine the frequency, pattern and management of acute abdomen in patients with dengue fever. METHODS: This descriptive case series is a prospective analysis of acute abdomen in dengue fever that was performed at three secondary care hospitals in Karachi, Pakistan from June 1, 2005 to December 31, 2008. The inclusion criterion was all patients with confirmed diagnosis of dengue fever. Patients with incomplete laboratory, ultrasound or histopathology data were excluded. RESULTS: Among 357 patients with dengue fever, 43 (12.04%) had acute abdomen. There were 15 men and 28 women, with a median age of 29 years. These included 26 cases of acute cholecystitis, 7 cases of acute appendicitis, 7 cases of nonspecific peritonitis, and 3 cases of acute pancreatitis. Dengue hemorrhagic fever/shock syndrome was found in acute pancreatitis, and two of these patients died. Emergency surgery was required in eight patients (5 appendectomy and 3 open cholecystectomy). Substantial transfusion of blood and its components was required in eight patients who underwent emergency surgery. CONCLUSION: Early diagnosis and prompt conservative management of dengue acute abdomen is necessary to avoid mortality and emergency surgery-related morbidity. However, if needed, surgery can be performed with acceptable morbidity.

Acute abdomen by varicella zoster virus induced gastritis after autologous peripheral blood stem cell transplantation in a patient with non-Hodgkin's lymphoma.

We report on a 54-year-old male patient with an aggressive T cell non-Hodgkin's lymphoma with abdominal manifestation undergoing autologous peripheral blood stem cell transplantation after high-dose chemotherapy in April 2003. About 4 months after transplantation, he developed severe upper abdominal pain. Ultrasound examination, X-ray, computed tomography of the abdomen and cardiac diagnostics could not explain the symptoms. While empiric therapy with high-dose acyclovir was started, we could document herpetic lesions in the gastric antrum by endoscopy. The epigastric pain rapidly decreased within several days after the start of acyclovir therapy. No herpetic skin lesions were observed at any time during the disease. This report demonstrates the importance of viral-induced gastritis in the differential diagnosis of severe abdominal pain in patients receiving autologous peripheral blood stem cell transplantation.

Severe acute respiratory syndrome mimicking acute abdomen.

Severe acute respiratory syndrome (SARS) is a novel epidemic disease. The clinical presentation can sometimes be very non-specific. The present study reports a case of SARS, which presented as acute abdomen, warranting laparotomy. The atypical presentation in the present case reminded us of the importance of strict infection control measures in all surgery-related specialist workplaces.