Falqueto Loraine Entringer, Vissoci Carolina Martins, Ferreira Isabella Cristina Bonetto, Antunes Amanda Ginani, Amado Fernando Antônio Bersani, Avilla Sylvio Andrade Gilberto, Schulz Claudio, Motta Fabio Araujo, Silva Elisangela DE Mattos E
- Hospital Pequeno Principe, Departamento de Cirurgia Pediatrica - Curitiba - PR - Brasil.
- Hospital Pequeno Principe, Departamento de Infectologia, Núcleo de Pesquisa Clínica e Núcleo da Qualidade - Curitiba - PR - Brasil.
Rev Col Bras Cir. 2022 Jan 5;48:e20213012. doi: 10.1590/0100-6991e-20213012. eCollection 2022.
the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil.
It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms.
MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.
新型冠状病毒大流行在2020年一直是现实存在的，并且带来了巨大挑战。该病毒在儿童群体中主要表现为轻微症状。然而，文献中已描述了与新冠病毒相关的儿童多系统炎症综合征（MIS-C）发病率的增加。MIS-C主要表现为发热和胃肠道症状，并且可能因急性阑尾炎而类似急腹症。本研究的目的是针对大流行时期初始阶段疑似急性阑尾炎病例提出一个护理流程图，同时考虑到MIS-C的可能性。这种情况是由巴西一家儿科医院治疗的一名患者引发的。
在报告的患者以及已发表病例中能够识别出一些常见的体征和症状，这些可作为早期识别MIS-C病例的警示信号。基于文献综述以及该综合征与儿童炎症性急腹症之间的相似性，我们为这些病例制定了一种初始处理方法，以促进识别、早期诊断和管理。该流程图考虑了初始阶段症状患者在进行阑尾切除术指征之前的临床病史、体格检查和辅助检查的细节。
MIS-C虽然罕见且病理生理学鲜为人知，但通常病情严重且有很高的死亡风险。使用所提出的流程图有助于MIS-C的诊断和早期治疗。
