Pediatric Multisystem Inflammatory Syndrome in Children as a Challenging Problem for Pediatric Surgeons in the COVID 19 Pandemic—A Case Report

Abstract

The first cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were identified at the end of 2019 and, in the next few months, coronavirus disease (COVID-19) spread throughout the world. Initially, it was believed that this disease mainly affected elderly individuals with comorbidities, in whom respiratory failure often occurs. It was believed that children fell ill from the infection more often, although the course of infection in the vast majority of pediatric cases has been asymptomatic or mildly symptomatic. In April and May 2020, the first report of a rapidly progressing disease, similar to Kawasaki syndrome, was found in children who had been infected with SARS-CoV-2. Shortly thereafter, children with symptoms of pediatric inflammatory multisystem syndrome (PIMS-ST [temporally associated with SARS-CoV-2 infection]) began presenting to pediatric hospitals around the world. The syndrome has a mortality rate of up to 2%. Symptoms of PIMS-TS include those that may suggest the need for surgical treatment (severe abdominal pain with the presence of peritoneal symptoms, ascites, high levels of inflammatory markers, intestinal inflammation, and appendages revealed on ultrasound examination). However, there are few reports addressing surgical cases associated with this condition. The authors present a case involving an 11-year-old boy who was admitted to hospital with severe abdominal pain and underwent surgery for symptoms of peritonitis and was diagnosed with PIMS in the post-operative period. Due to the large number of illnesses caused by SARS-CoV-2 infection in recent months, the diagnosis of PIMS-TS/MISC should be considered in the differential diagnosis of acute abdominal symptoms, especially in atypical courses and interviews indicating exposure to SARS-CoV-2.

Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS) — A mimic of intra-abdominal malignancy

“…A small case series of children with PIMS-TS describes two children who developed signs of intestinal obstruction, one of whom required bowel resection; it is unclear from the manuscript whether the diagnosis of PIMS-TS was made before or after significant bowel involvement occurred. 5 There are also several case reports of children who underwent appendicectomy for what was later diagnosed as PIMS-TS after presenting with fever and abdominal pain. 6–8 There has also been a case report of a child who presented with possible appendicitis but rapidly deteriorated due to cardiac involvement of PIMS-TS.…”

“…We are aware of only a single case report of such marked mesenteric lymphadenopathy in an adult patient,4 and a small number in children. A small case series of children with PIMS-TS describes two children who developed signs of intestinal obstruction, one of whom required bowel resection; it is unclear from the manuscript whether the diagnosis of PIMS-TS was made before or after significant bowel involvement occurred 5. There are also several case reports of children who underwent appendicectomy for what was later diagnosed as PIMS-TS after presenting with fever and abdominal pain 6–8.…”

Multisystem Inflammatory Syndrome in Children (MIS-C) in Pediatric Patient Post Cardiac Surgery: A Case Report

“…[4] There are several clinical presentation found in MIS-C patients, such as fever, mucocutaneous involvement, conjunctival alterations, gastrointestinal symptoms mostly abdominal pain, cardiovascular manifestations (tachycardia, hemodynamic shock, myocarditis, decreased LVEF), respiratory symptoms, thrombotic complications with elevated markers of inflammation and evidence of COVID-19 (RT-PCR, antigen test or serology positive). [5,6] Over the course of the pandemic, MIS-C management has changed. Most MIS-C patients were treated with intravenous immunoglobulins and intravenous glucocorticoids, and additional interventions such as antithrombotic therapy and biologic therapy depend upon the severity of illness, constellation of findings, and response to initial therapy.…”