Sir,
We recently managed five children who had either acute severe COVID-19 disease or Multisystem Inflammatory Syndrome in Children (MIS-C), and who had presented with an acute abdomen but did not have any respiratory complaints at presentation.[1,2] None of the children required invasive mechanical ventilation and all survived [Table 1].
Table 1.
Patient characteristics at admission
| Variables of interest (normal range) | Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 |
|---|---|---|---|---|---|
| Age (years) | 7 | 8 | 10 | 11 | 14 |
| Sex | Female | Male | Female | Female | Female |
| Acute severe COVID-19 or MIS-C | MIS-C | MIS-C | MIS-C | Acute severe COVID-19 | Acute severe COVID-19 |
| Immediate underlying abdominal condition | Colitis | Ileitis | Acute edematous pancreatitis | Perforated appendicitis | Perforated appendicitis |
| SARS-CoV-2 RTPCR | Negative | Negative | Positive | Positive | Positive |
| Anti SARS-CoV-2 spike antibody IgG (<0.8 U/mL) | Positive (68.36) | Positive (91.4) | - | - | - |
| CRP (<0.6 mg/dL) | 19.7 | 3.28 | 9 | 6.36 | 9 |
| Procalcitonin (<0.5 ng/mL) | 9.49 | 0.29 | 0.15 | 29.99 | 0.24 |
| D-dimer (<0.5 µg FEU/mL) | 4.89 | 2.23 | 31.23 | 10 | 4.91 |
| Ferritin (13–150 ng/mL) | 231.4 | 118.4 | 233.7 | 15.95 | 140.2 |
| LDH (85–227 U/L) | - | 178 | 415 | 447 | 573 |
| Amylase (25–125) U/L | 27 | 36 | 66 | - | - |
| Lipase (5–31) U/L | 77.8 | 11.2 | 76 | - | - |
| Ultrasound/CT imaging | Mesenteric lymphadenopathy, hepatomegaly, colon wall edema, leukoencepahlitis | Hepatomegaly, ascites, small bowel wall edema, pleural effusion, pulmonary alveolar hemorrhage | Acute edematous pancreatitis, ascites, colon wall edema, mesenteric lymphadenopathy, bilateral renal pyramid hypoenhancement, pleural effusion | Perforated appendicitis | Perforated appendicitis, splenomegaly |
COVID-19: Coronavirus disease 2019, MIS-C: Multisystem inflammatory syndrome in children, SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2, RTPCR: Reverse transcription-polymerase chain reaction, CRP: C-reactive protein, FEU: Fibrinogen, CT: Computed tomography, LDH: Lactate dehydrogenase, IgG: Immunoglobulin G
Two patients with MIS-C developed ascites and pleural effusions, but a drainage procedure was not needed in them. All three of our patients with MIS-C had bowel wall thickening, but none of them developed bowel obstruction.[1] Gastrointestinal symptoms can be seen in 90% of patients with MIS-C and can masquerade as a genuine surgical emergency.[1] Neither of our two patients who underwent an appendectomy developed any postoperative complications.
Our limited study indicates that children with COVID-19 who present with an initial acute abdomen do well if they do not have any associated primary involvement of the pulmonary parenchyma.
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Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Assa A, Benninga MA, Borrelli O, Broekaert I, de Carpi JM, Saccomani MD, et al. Gastrointestinal perspective of coronavirus disease 2019 in children-an updated review. J Pediatr Gastroenterol Nutr. 2021;73:299–305. doi: 10.1097/MPG.0000000000003204. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Feldstein LR, Tenforde MW, Friedman KG, Newhams M, Rose EB, Dapul H, et al. Characteristics and outcomes of us children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA. 2021;325:1074–87. doi: 10.1001/jama.2021.2091. [DOI] [PMC free article] [PubMed] [Google Scholar]