Acute abdomen in multisystem inflammatory syndrome in children: A systematic review

Abstract

Aim Multisystem inflammatory syndrome in children (MIS‐C), a rare severe complication of SARS‐CoV‐2 infection, has been recently reported to mimic acute abdomen and lead to surgical interventions, posing challenges for clinicians. In this systematic review, we evaluated the rate of acute abdomen and abdominal surgical emergencies in children with MIS‐C. Methods Systematic review of all MIS‐C cases presented with acute abdomen. Results A total of 385 patients with MIS‐C, from 38 studies, were included. Gastrointestinal manifestations were prominent in 233/385 (60.5%) children. Acute abdomen was noted in 72/385 (18.7%) of MIS‐C cases and in 72/233 (30.9%) of MIS‐C cases with gastrointestinal symptoms. Final diagnoses were mostly non‐surgical (55/72, 76.4%), such as mesenteric lymphadenitis (23/72, 31.9%), terminal ileitis/ileocolitis (19/72, 26.4%), free abdominal fluid/ascites (8/72, 11.1%) and paralytic ileus (3/72, 4.2%). Laparotomy was performed in 35/72 (48.6%) of children with MIS‐C, and acute abdomen and was proven unnecessary in 18/35 (51.4%) cases. True abdominal surgical emergencies, such as appendicitis and obstructive ileus, were confirmed in 17/72 (23.6%) cases. Conclusion MIS‐C often presents with acute abdomen, mostly due to non‐surgical intestinal inflammatory pathology. However, surgical complications occur in patients with MIS‐C; therefore, a high index of suspicion should remain.

Case Report: Simil-Appendicitis Presentation May Precede Cardiac Involvement in MIS-C Patient

“…As in our case, among all these values, increased inflammatory markers, lymphopenia and hypoalbuminemia are common findings in patients with gastrointestinal symptoms (4,6). Reviewing abdominal imaging in MIS-C patients, common US findings are ascites, acalculous cholecystitis, bowel wall thickening and mesenteric adenitis (4,(6)(7)(8). Moreover, in a systematic review Rouva et al reported an incidence of 30% of acute abdomen among MIS-C patient with gastrointestinal symptoms.…”

“…Despite gastrointestinal symptoms (abdominal pain, emesis and diarrhea) are common features in MIS-C patients, only in a few cases these manifestations resemble an acute appendicitis ( 5 – 7 , 13 – 15 ). Moreover, when these manifestations precede other organ involvement a differential diagnosis between inflammatory bowel disease, abdominal surgical conditions or severe infections could be difficult ( 13 – 16 ).…”

“…While adult patients with COVID-19 present gastrointestinal symptoms in only 15% of cases, up to 90% of MIS-C patients complain abdominal pain, diarrhea and vomiting. Gastrointestinal symptoms may be the first symptoms in MIS-C patients mimicking other conditions such as gastrointestinal infections or inflammatory bowel diseases (2,(4)(5)(6)(7). For this reason, laboratory exams and abdominal ultrasound can be helpful in differential diagnosis, though at the onset they can be indeterminate or unremarkable (2,4,(6)(7)(8).…”

Multisystem Inflammatory Syndrome Temporally Related to COVID-19 in Children From Latin America and the Caribbean Region: A Systematic Review With a Meta-Analysis of Data From Regional Surveillance Systems

“…In most reports, fever and abdominal or gastrointestinal symptoms (abdominal pain, diarrhea, and vomiting) are described as the most frequent ( 46 , 48 , 53 ). On the other hand, the presenting symptoms of MIS-C may mimic an acute abdomen, including acute appendicitis, as shown in a multicenter Latin-American study, in which 34/1,010 (3.3%) patients with COVID-19 and MIS-C had an intraoperative diagnosis of appendicitis ( 55 ). Furthermore, a systematic review of abdominal pain in MIS-C found an incidence of acute abdomen of 19%, which was non-surgical in most cases.…”

COVID-19 and the paediatric acute abdomen—the emerging dilemma of PIMS-TS

“…In a systematic review evaluating 385 cases of MIS-C, gastrointestinal symptoms were a feature of a patient’s presentation in 60.5 per cent of cases. 4 Although many of these patients were eventually diagnosed with a non-surgical pathology such as mesenteric adenitis or terminal ileitis, 48.6 per cent who presented with an ‘acute abdomen’ underwent a laparotomy, 51.4 per cent of which were negative. A surgical pathology such as acute appendicitis or obstructive ileus were confirmed in 23.6 per cent of cases, suggesting that relying on clinical findings alone might be insufficient while we better understand this emerging disease process.…”