Phlegmonous appendicitis in children with coronavirus infection COVID-19

The increase in cases of appendicitis observed during the COVID-19 pandemic requires an analysis of the causes of this situation and the determination of tactics for the diagnostic and surgical treatment of these patients. In 2020–2022 at the St. Vladimir Children’s Clinical Hospital, among hospitalized and operated patients for appendicitis, 16 patients were identified who simultaneously had a positive result of testing a swab from the nasopharynx for the presence of SARS-CoV-2 RNA. All patients are schoolchildren with a predominance of high school students. The disease began acutely with the appearance of abdominal pain, accompanied by repeated vomiting. There was no high fever, in half of the cases the temperature was subfebrile (37.2–37.8 °C), in other cases it remained normal. The respiratory syndrome preceded the abdominal one in three patients, and six more patients had hyperemia of the palatine arches and posterior pharyngeal wall. Respiratory failure, hypoxia were absent. Chest CT showed no changes. In all cases, abdominal ultrasound revealed ECHO signs of inflammatory transformation of appendix fragments. Operations were performed laparoscopically. The results of the morphological study of the removed appendix corresponded to the diagnosis of phlegmonous appendicitis, periappendicitis, mesenteriolitis. The postoperative course was uncomplicated, the pain syndrome was stopped, there was an improvement in clinical and laboratory parameters. Conclusion: phlegmonous appendicitis was observed in patients with coronavirus infection; surgical treatment led to the recovery of patients.

1. Mehta P, McClufey D.F., Broun M et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet, 2020, 395 (10229), 1033–1034.

2. A.V. Bregel, M.M. Kostik, A.Z. Fell et al. Kawasaki disease and multisystem inflammatory syndrome in children with COVID-19 infection. Pediatrics. G.N. Speransky, 2020, 99 (6). 209–219.

3. Mc Cormic D.W., Richard L.C., Yong P.R. Et al. Deaths in Children Adoles cents Assotiated with COVID-19 and Mic-c in the United States. Pediatrics, 2021, Nov 148 (5): e 2021. 052273. DOI: 10?1542/ped.520.

4. Suresh Kumar V.C., Mukherjee S., Harne P.S. et al. Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19. BMJ Open Gastr. 2020; 7 (1): e000417. DOI: 10.1136/bmjgast-2020–000417.

5. Tullie L., Ford K., Bisharat M. et al. Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children. Lancet Child Adolesc Health. 2020; 4 (7): e19–e20. DOI: 10.1016/s2352–4642(20)30165–6.

6. Malhotra A, Sturgill M, Whitley-Williams P, Lee YH, Esochaghi C, Rajasekhar H, Olson B, Gaur S. Pediatric COVID-19 and Appendicitis: A Gut Reaction to SARS-CoV-2? Pediatr Infect Dis J. 2021 Feb 1; 40 (2): e49–e55. DOI: 10.1097/inf.0000000000002998. PMID: 33298761.

7. Salman R, Sher AC, Guillerman RP, Seghers VJ, Rodriguez JR, Sangi-Haghpeykar H, Annapragada AV, Sammer MBK. Acute appendicitis and SARS-CoV-2 in children: imaging findings at a tertiary children’s hospital during the COVID-19 pandemic. Pediatr Radiol. 2022 Mar; 52 (3): 460–467. DOI: 10.1007/s00247–021–05219–0. Epub 2021 Nov 5. PMID: 34741178; PMCID: PMC8570768.

8. Köhler F, Müller S, Hendricks A, Kastner C, Reese L, Boerner K, Flemming S, Lock JF, Germer CT, Wiegering A. Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis. Int J Surg. 2021 Nov; 95: 106148. DOI: 10.1016/j.ijsu.2021.106148. Epub 2021 Oct 23.

9. Pellicciaro M, Vanni G, Grande S, Materazzo M, Santori F, DI Cesare T, Manuelli MC, Sforza D, Villa M, Venditti D, Grande M. Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Increasing Incidence of Complicate Appendicitis, Severity and Length of Hospitalization. In Vivo. 2022 May-Jun; 36 (3): 1325–1332. DOI: 10.21873/invivo.12833. PMID: 35478123; PMCID: PMC9087104.

10. Delgado-Miguel C, Muñoz-Serrano AJ, Miguel-Ferrero M, De Ceano-Vivas M, Calvo C, Martínez L. Complicated Acute Appendicitis during COVID-19 Pandemic: The Hidden Epidemic in Children. Eur J Pediatr Surg. 2022 Jun; 32 (3): 268–273. DOI: 10.1055/s-0041–1723992.

11. Wolf S, Schrempf M, Vlasenko D, Schoeler C, Erckmann F, Von Parpart P, Paschwitz R, Anthuber M, Sommer F. Acute appendicitis during the COVID-19 pandemic-changes in incidence and clinical presentation but not in patients’ outcome. Int J Qual Health Care. 2022 Mar 1; 34 (1): mzac005. DOI: 10.1093/intqhc/mzac005.

12. Buryachkovskaya L.I. Heterotropy of human and animal platelets, the relationship of morphological features with the functional state. Auth. Dissertation degree of doctor of sciences, M. 2007.

13. Mazurov A.V., Khaspekova S.G., Vasiliev S.A. Diagnosis of thrombocytopenia. Therapeutic Archive 2018, 90 (7) 4–13.