COVID-19-Related Intestinal Ischemia in A 7-Year Old Boy

Abstract

Severe abdominal pain and vomiting are common symptoms in children with pediatric multisystem inflammatory syndrome (PIMS). Mesenteric lymphadenitis and aseptic peritonitis are predominantly reported in cases where acute surgical abdomen was suspected and laparotomy was performed at the early stage of the pandemic. These reports generally discouraged surgeons to perform exploration in COVID-19-related cases and medical management was prioritized. Only a few COVID-19-specific surgical cases with intestinal ischemia were published. Here, we report another case of COVID-19-related intestinal ischemia complicated with Meckel's diverticulitis in a non-immunocompromised child who clearly required surgical intervention. In our case, the combination of COVID-19-related vasculitis and low blood pressure episodes may have contributed to this severe outcome.

Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis

“…Subsequently, 103 articles remained, which were analyzed in full text. In total, 34 studies met our inclusion criteria and reported SARS-CoV-2 infection in pediatric patients with ISN and were included for systematic review and meta-analysis [ 4 , 5 , 6 , 7 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The detailed characteristics of the included studies are shown in Table 1 .…”

“…The detailed characteristics of the included studies are shown in Table 1 . There were 28 case report [ 4 , 6 , 7 , 15 , 16 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ], 5 cohort [ 20 , 34 , 42 , 43 , 44 ] and 1 case-series [ 5 ] studies. These studies were conducted in United States (n = 9), Italy (n = 4), United Kingdom (n = 3), China (n = 3), India (n = 3), Iran (n = 2), Colombia (n = 2), Jordan (n = 1), Peru (n = 1), Hungary (n = 1), Guatemala (n = 1), Spain (n = 1), Mexico (n = 1), Pakistan (n = 1), and Turkey (n = 1).…”

“…These studies were conducted in United States (n = 9), Italy (n = 4), United Kingdom (n = 3), China (n = 3), India (n = 3), Iran (n = 2), Colombia (n = 2), Jordan (n = 1), Peru (n = 1), Hungary (n = 1), Guatemala (n = 1), Spain (n = 1), Mexico (n = 1), Pakistan (n = 1), and Turkey (n = 1). The majority of the studies were single center [ 4 , 5 , 7 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 43 , 44 ], and only four studies were multicenter [ 6 , 28 , 36 , 42 ]. Among the 34 included studies, 5 cohort studies were assessed using the NOS: 4 studies were found to be moderate-quality studies (i.e., NOS scores between 5 and 7) and 1 study demonstrated a relatively high quality (i.e., NOS scores > 7).…”

“…Most of the patients were in the 1-12 months age group (n = 32, 50%), p = 0.001 [ 4 , 5 , 6 , 7 , 15 , 16 , 17 , 18 , 20 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 35 , 36 , 38 , 39 , 40 , 41 , 43 ]. There was an increased male predominance in ISN patients diagnosed with SARS-CoV-2 in most of the studies (n = 41, 64.1%, p = 0.000) [ 4 , 7 , 15 , 16 , 17 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 42 ], and the majority of the patients belonged to White (Caucasian) (n = 25, 39.1%), Hispanic (n = 13, 20.3%) and Asian (n = 5, 7.8%) ethnicity, p = 0.000 [ 4 …”

“…There was an increased male predominance in ISN patients diagnosed with SARS-CoV-2 in most of the studies (n = 41, 64.1%, p = 0.000) [ 4 , 7 , 15 , 16 , 17 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 42 ], and the majority of the patients belonged to White (Caucasian) (n = 25, 39.1%), Hispanic (n = 13, 20.3%) and Asian (n = 5, 7.8%) ethnicity, p = 0.000 [ 4 , 5 , 6 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 30 , 31 , 32 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The reported ISN classification by location were mostly ileocolic (n = 35, 54.7%) [ ...…”