Ardila Gómez Iván José, López Pilar Pérez, Duque Darling Carvajal, García Doris Martha Salgado, Romero Andres Felipe, Vega Martha Rocío Vega, Ramos Castañeda Jorge Andres
Pediatric Critical Care, Colombia.
Clínica Uros, Neiva, Huila, Colombia.
J Pediatr Surg Case Rep. 2021 Nov;74:102042. doi: 10.1016/j.epsc.2021.102042. Epub 2021 Sep 16.
Multisystemic inflammatory syndrome (MIS-C) can develop as a complication of SARS CoV-2 infection, involving the gastrointestinal system mainly by vasoconstriction, edema, glandular hyperplasia, and a procoagulant state leading to direct tissue injury.
ology: a series of cases including 8 patients with MIS-C treated in two highly complex institutions is presented. These patients, had abdominal symptoms of surgical management.
The average age was 9.5 years and the most frequent symptoms were fever, abdominal pain, diarrhea (100%); in addition, 87.5% presented shock. The diagnosis of SARS CoV-2 was confirmed by RT-PCR test in 37.5%, antigen 12.5% and the rest of the patients showed IgM and IgG antibodies. In laboratories, the increase in acute phase reactants, Erythrocyte Sedimentation Rate (ESR), C-reactive protein, procalcitonin, as well as troponin, D dimer and proBNP, is highlighted. The surgical outcome documented 2 patients with a normal appendix, 3 patients with edematous appendicitis, and 3 patients with complicated appendicitis.
patients with MIS-C display abdominal symptoms similar to those present in surgical emergencies and a non-negligible number of cases require surgical exploration. This condition poses a new differential diagnosis to the surgical abdomen in pediatric patients.
多系统炎症综合征(MIS-C)可作为SARS-CoV-2感染的并发症出现,主要通过血管收缩、水肿、腺体增生和促凝状态累及胃肠道系统,导致直接组织损伤。
介绍了在两个高度复杂的机构中治疗的一系列病例,包括8例MIS-C患者。这些患者有需要手术处理的腹部症状。
平均年龄为9.5岁,最常见的症状是发热、腹痛、腹泻(100%);此外,87.5%的患者出现休克。37.5%的患者通过RT-PCR检测确诊为SARS-CoV-2,12.5%通过抗原检测确诊,其余患者显示IgM和IgG抗体。在实验室检查中,急性期反应物、红细胞沉降率(ESR)、C反应蛋白、降钙素原以及肌钙蛋白、D-二聚体和脑钠肽前体均升高。手术结果显示,2例患者阑尾正常,3例患者为水肿性阑尾炎,3例患者为复杂性阑尾炎。
MIS-C患者表现出与外科急症相似的腹部症状,相当数量的病例需要进行手术探查。这种情况给儿科患者的外科急腹症带来了新的鉴别诊断。