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J Pediatr Infect Dis 2022; 17(01): 024-032
DOI: 10.1055/s-0041-1739394
Original Article

Acute Abdomen—A Clinical Presentation of MIS-C in Children

Emrah Gün
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Tanıl Kendirli 
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Edin Botan
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Berrin Demir 
2   Department of Pediatric Radiology, Ankara University School of Medicine, Ankara, Turkey
,
Ergun Ergün
3   Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
,
Halil Özdemir
4   Department of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
,
Ömer Suat Fitoz 
2   Department of Pediatric Radiology, Ankara University School of Medicine, Ankara, Turkey
,
Ergin Ciftci 
4   Department of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
,
Ercan Tutar
5   Department of Pediatric Cardiology, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
› Author Affiliations Funding None.
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Abstract

Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent fever, systemic hyperinflammation, and multiple-organ dysfunction. There are a few reports about MIS-C presenting with acute abdomen. The aim of this study was to demonstrate the clinical characteristics and treatment options for MIS-C-related acute abdomen and appendicitis.

Methods This was a retrospective study conducted between April 2020 and October 2020 in our pediatric intensive care unit in Turkey. Patients between the ages of 1 month and 18 years who presented with acute abdomen and were ultimately diagnosed with MIS-C were included.

Results Seven patients with a median age of 12.5 (interquartile range 10.5–13) years were enrolled. Four were females. The most frequent symptoms were fever, abdominal pain, and vomiting. Three patients had involvement of the appendix that required surgical intervention. All pathology reports were compatible with appendicitis. The other patients also had an acute abdomen. One patient had malignant hyperthermia during induction of anesthesia, so surgery was postponed and medical management was commenced. The clinical picture regressed with immunomodulation. All patients were treated with intravenous immunoglobulin and steroids. Four patients with acute abdomens improved with immunomodulation, and surgery was not needed.

Conclusion MIS-C may present with an acute abdomen. Immunomodulation should be considered instead of surgery if the clinical course is not complicated.

Keywords

multisystem inflammatory syndrome in children - COVID-19 - intestinal inflammation - appendicitis - children

Consent to Participate

Approval was obtained from the family of the participants.


Ethical Approval

Ethical committee approval was received for this study from the Ethics Committee of Ankara University Medical Faculty by the number i2-143-21.


Authors' Contributions

T.K. and E.G. were responsible for the concept; E.G., E.D., E.E., and B.A. for the design; T.K., E.Ç., E.T., H.Ö., and S.F. for supervision; E.G., T.K., and E.D. for materials; E.G., T.K., and E.D. for data collection and/or processing; T.K. and E.G. for the analysis and/or interpretation; T.K., E.G., and E.D. for the literature review; T.K. and E.G. for writing; and T.K., E.T., E.Ç., E.E., S.F., and H.Ö. for critical review.




Publication History

Received: 12 May 2021

Accepted: 30 September 2021

Article published online:
06 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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