Acute surgical abdomen as presenting manifestation of Kawasaki disease

Zulian, Francesco; Falcini, Fabio; Zancan, Lucia; Martini, Giorgia; Secchieri, Silvia; Luzzatto, C; Zacchello, Franco

doi:10.1067/mpd.2003.232

Cited by 146 publications

(141 citation statements)

References 20 publications

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“…These data highlight the missed opportunities to make a diagnosis of KS earlier in some of these patients. There are multiple other descriptions in the literature of patients ultimately diagnosed with KS who were initially given the diagnosis of other entities such as cervical adenitis, 10-12 meningitis, 13,14 pneumonia, 15 appendicitis, 16,17 or pyelonephritis. 18 It is interesting to note that in this study, the children in the DDG were overrepresented in the group of children hospitalized before the diagnosis of KS, which suggests that either children in the DDG presented incompletely 19 or the provider was focused on only 1 sign or aspect of illness (ie, adenopathy for admitting diagnosis of adenitis).…”

Section: E430mentioning

confidence: 99%

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

2005

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ABSTRACT.Objective. Most pediatric providers in Colorado are familiar with Kawasaki syndrome (KS). However, in a recent outbreak, 30% of cases were diagnosed after illness day 10. We hypothesized that these children saw providers who were not familiar with KS, were given antibiotics for other diagnoses that delayed identification, had access-to-care issues, or presented atypically.Methods. A retrospective chart review of 106 consecutive KS cases seen at the Children's Hospital in Denver during 1994 -2000 was conducted.Results. Twenty-five of 106 children (23.6%) were diagnosed after day 10 of illness (delayed-diagnosis group [DDG]), and these 25 cases were compared with 81 cases diagnosed on or before day 10 (early-diagnosis group [EDG]). There were no differences between patients in the DDG and EDG in age, gender, number of visits, specialty of the primary care physician, time to the first medical visit, number of antibiotics received, coronary artery abnormalities, white blood cell count, or erythrocyte sedimentation rate. Patients in the DDG had significantly more days of fever, rash, red eyes, and oral changes. A platelet count of >450 000/mm 3 occurred more often in the DDG (56%) than the EDG (30%). After additional analysis, patients in the EDG had close clustering of symptom onset in the first few days of illness, but patients in the DDG had onset of symptoms scattered over 9 days. Patients in the DDG were 2.8 times more likely to have coronary artery aneurysms than patients in the EDG (DDG: 24%; EDG: 8.6%).Conclusions. Diagnosis after the 10th day of illness was not linked to type of medical provider, number of antibiotics received, or number of physician visits. Patients in the DDG exhibited the typical features of KS, but the onset of their symptoms was dispersed over time as opposed to the close clustering of symptoms in the EDG. Because coronary artery aneurysms occurred significantly more often in the patients in the DDG, more education is needed to teach health care providers to have a high index of suspicion for KS in young children presenting with fever/rash illnesses.

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Section: E430mentioning

confidence: 99%

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

2005

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“…Rarely, Kawasaki disease can present as an acute surgical abdomen. 65 Hepatic enlargement and jaundice can occur. Acute acalculous distention of the gallbladder (hydrops) occurs in Ϸ15% of patients during the first 2 weeks of the illness and can be identified by abdominal ultrasound.…”

Section: Noncardiac Findingsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,602

818

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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“…20 In 2 cases, IVIG was administered at the time of bowel symptoms (1 after a laparotomy), and in both there seems to have been a subsequent rapid resolution of symptoms. 1,2 In the present case, the intestinal symptoms had resolved with conservative management by the time the child was recognized as having KD and given IVIG.…”

Section: Discussionmentioning

confidence: 80%

“…Finally, Fang et al 2 report on 1 child who developed coronary artery abnormalities after presenting with predominant symptoms of fever, abdominal distension, and vomiting. It is unclear whether these outcomes reflect the delay that may occur in recognizing and treating these children or whether, as has been suggested by some, 1,20 it is a marker of a more significant vasculitis in those who develop this complication.…”

Section: Discussionmentioning

confidence: 94%

“…Abdominal symptoms, including those of bowel obstruction, may be a prominent early feature of KD and can occur before the development of more well recognized clinical features. 1,2 Failure to appreciate this may lead to a delay in diagnosis and treatment, with potential consequences for the development of cardiac sequelae. We present the case of a 3 1 ⁄2 -year-old boy admitted to hospital with fever and what initially was felt to be gastroenteritis.…”

Section: T He Individual Clinical Features Of Kawasaki Disease (Kd) Amentioning

confidence: 99%

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Intestinal Pseudoobstruction in Kawasaki Disease

Akikusa

Laxer

Friedman³

2004

Pediatrics

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ABSTRACT. Intestinal pseudoobstruction is an uncommon but important manifestation of Kawasaki disease. Its occurrence at the onset or during the course of the disease may confuse the clinical picture and cause delay in diagnosis and treatment. This delay may be responsible for the high rate of coronary artery abnormalities that have been reported in patients with this complication. We suggest that Kawasaki disease be considered in the differential diagnosis of any child presenting with intestinal pseudoobstruction and fever without definable cause.

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Acute surgical abdomen as presenting manifestation of Kawasaki disease

Cited by 146 publications

References 20 publications

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Intestinal Pseudoobstruction in Kawasaki Disease

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