Download PDF
Eur J Pediatr Surg 2021; 31(04): 311-318
DOI: 10.1055/s-0041-1731295
Review Article

Impact of the Global COVID-19 Pandemic on the Incidence, Presentation, and Management of Pediatric Appendicitis: Lessons Learned from the First Wave

Kerstin Saalabian
1   Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
,
Udo Rolle 
1   Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
,
Florian Friedmacher 
1   Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.

Keywords

appendicitis - child - pediatric - coronavirus - COVID-19 - SARS-CoV-2 - MIS-C - PIMS-TS


Publication History

Received: 25 April 2021

Accepted: 10 May 2021

Article published online:
23 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Zhu N, Zhang D, Wang W. et al; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382 (08) 727-733
    CrossrefPubMedGoogle Scholar
  • 2 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
    CrossrefPubMedGoogle Scholar
  • 3 Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020; 91 (01) 157-160
    CrossrefPubMedGoogle Scholar
  • 4 World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. Accessed May 28, 2021 at: https://covid19.who.int
    PubMedGoogle Scholar
  • 5 Rasmussen SA, Thompson LA. Coronavirus disease 2019 and children: what pediatric health care clinicians need to know. JAMA Pediatr 2020; 174 (08) 743-744
    CrossrefPubMedGoogle Scholar
  • 6 Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020; 109 (06) 1088-1095
    CrossrefPubMedGoogle Scholar
  • 7 Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19 - implications for the health care system. N Engl J Med 2020; 383 (15) 1483-1488
    CrossrefPubMedGoogle Scholar
  • 8 Urbach DR, Martin D. Confronting the COVID-19 surgery crisis: time for transformational change. CMAJ 2020; 192 (21) E585-E586
    CrossrefPubMedGoogle Scholar
  • 9 Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA 2020; 324 (08) 782-793
    CrossrefPubMedGoogle Scholar
  • 10 Emanuel EJ, Persad G, Upshur R. et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med 2020; 382 (21) 2049-2055
    CrossrefPubMedGoogle Scholar
  • 11 DeFazio JR, Kahan A, Fallon EM. et al. Development of pediatric surgical decision-making guidelines for COVID-19 in a New York City children's hospital. J Pediatr Surg 2020; 55 (08) 1427-1430
    CrossrefPubMedGoogle Scholar
  • 12 Skarsgard ED. Pediatric Surgical Chiefs of Canada. Prioritizing specialized children's surgery in Canada during the COVID-19 pandemic. CMAJ 2020; 192 (41) E1212-E1213
    CrossrefPubMedGoogle Scholar
  • 13 Qazi SH, Saleem A, Pirzada AN, Hamid LR, Dogar SA, Das JK. Challenges to delivering pediatric surgery services in the midst of COVID 19 crisis: experience from a tertiary care hospital of Pakistan. Pediatr Surg Int 2020; 36 (11) 1267-1273
    CrossrefPubMedGoogle Scholar
  • 14 Gunadi IY, Idham Y, Paramita VMW, Fauzi AR, Dwihantoro A, Makhmudi A. The impact of COVID-19 pandemic on pediatric surgery practice: a cross-sectional study. Ann Med Surg (Lond) 2020; 59: 96-100
    CrossrefPubMedGoogle Scholar
  • 15 Dedeilia A, Esagian SM, Ziogas IA, Giannis D, Katsaros I, Tsoulfas G. Pediatric surgery during the COVID-19 pandemic. World J Clin Pediatr 2020; 9 (02) 7-16
    CrossrefPubMedGoogle Scholar
  • 16 Pelizzo G, Costanzo S, Maestri L. et al. The challenges of a children's hospital during the COVID-19 pandemic: the pediatric surgeon's point of view. Pediatr Rep 2020; 12 (03) 114-123
    CrossrefPubMedGoogle Scholar
  • 17 Sømme S, Bronsert M, Morrato E, Ziegler M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 2013; 132 (06) e1466-e1472
    CrossrefPubMedGoogle Scholar
  • 18 Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990; 132 (05) 910-925
    CrossrefPubMedGoogle Scholar
  • 19 Almström M, Svensson JF, Svenningsson A, Hagel E, Wester T. Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013. BJS Open 2018; 2 (03) 142-150
    CrossrefPubMedGoogle Scholar
  • 20 Aarabi S, Sidhwa F, Riehle KJ, Chen Q, Mooney DP. Pediatric appendicitis in New England: epidemiology and outcomes. J Pediatr Surg 2011; 46 (06) 1106-1114
    CrossrefPubMedGoogle Scholar
  • 21 Andersen SB, Paerregaard A, Larsen K. Changes in the epidemiology of acute appendicitis and appendectomy in Danish children 1996-2004. Eur J Pediatr Surg 2009; 19 (05) 286-289
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Stringer MD. Acute appendicitis. J Paediatr Child Health 2017; 53 (11) 1071-1076
    CrossrefPubMedGoogle Scholar
  • 23 Gray DT, Mizrahi T. Trends in appendicitis and perforated appendicitis prevalence in children in the United States, 2001-2015. JAMA Netw Open 2020; 3 (10) e2023484
    CrossrefPubMedGoogle Scholar
  • 24 Baxter KJ, Nguyen HTMH, Wulkan ML, Raval MV. Association of health care utilization with rates of perforated appendicitis in children 18 years or younger. JAMA Surg 2018; 153 (06) 544-550
    CrossrefPubMedGoogle Scholar
  • 25 Newman K, Ponsky T, Kittle K. et al. Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 2003; 38 (03) 372-379
    CrossrefPubMedGoogle Scholar
  • 26 Scott C, Lambert A. Managing appendicitis during the COVID-19 pandemic in the UK. Br J Surg 2020; 107 (08) e271
    CrossrefPubMedGoogle Scholar
  • 27 Ielpo B, Podda M, Pellino G. et al. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study. Br J Surg. 2020 DOI: 10.1002/bjs.11999
    CrossrefPubMedGoogle Scholar
  • 28 Lock JF, Wiegering A. Changes in the management of acute appendicitis during the COVID-19 pandemic. Langenbecks Arch Surg 2021; 406 (02) 503-504
    CrossrefPubMedGoogle Scholar
  • 29 Collard M, Lakkis Z, Loriau J. et al. Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: changes in treatment modalities related to the COVID-19 health crisis. J Visc Surg 2020; 157 (3S1): S33-S42
    CrossrefPubMedGoogle Scholar
  • 30 Gibney E. Whose coronavirus strategy worked best? Scientists hunt most effective policies. Nature 2020; 581 (7806): 15-16
    CrossrefPubMedGoogle Scholar
  • 31 Leva E, Morandi A, Sartori A, Macchini F, Berrettini A, Manzoni G. Correspondence from Northern Italy about our experience with COVID-19. J Pediatr Surg 2020; 55 (05) 985-986
    CrossrefPubMedGoogle Scholar
  • 32 Place R, Lee J, Howell J. Rate of pediatric appendiceal perforation at a children's hospital during the COVID-19 pandemic compared with the previous year. JAMA Netw Open 2020; 3 (12) e2027948
    CrossrefPubMedGoogle Scholar
  • 33 Hassoun A, Kadenhe-Chiweshe A, Sharma M. New York's COVID-19 shelter-in-place and acute appendicitis in children. J Pediatr Surg 2021; 56 (03) 635-636
    CrossrefPubMedGoogle Scholar
  • 34 Bonilla L, Gálvez C, Medrano L, Benito J. [Impact of COVID-19 on the presentation and course of acute appendicitis in paediatrics]. An Pediatr (Barc) 2021; 94 (04) 245-251
    CrossrefPubMedGoogle Scholar
  • 35 Tirabassi MV. Considerations for the outpatient practice in pediatric surgery during the novel SARS-CoV-2 pandemic. J Pediatr Surg 2020; 55 (06) 1169-1170
    CrossrefPubMedGoogle Scholar
  • 36 Schanzer DL, Schwartz B. Impact of seasonal and pandemic influenza on emergency department visits, 2003-2010, Ontario, Canada. Acad Emerg Med 2013; 20 (04) 388-397
    CrossrefPubMedGoogle Scholar
  • 37 Paek SH, Kim DK, Lee JH, Kwak YH. The impact of Middle East respiratory syndrome outbreak on trends in emergency department utilization patterns. J Korean Med Sci 2017; 32 (10) 1576-1580
    CrossrefPubMedGoogle Scholar
  • 38 Garcia S, Albaghdadi MS, Meraj PM. et al. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol 2020; 75 (22) 2871-2872
    CrossrefPubMedGoogle Scholar
  • 39 Pines JM, Zocchi MS, Black BS. et al; US Acute Care Solutions Research Group. Characterizing pediatric emergency department visits during the COVID-19 pandemic. Am J Emerg Med 2021; 41: 201-204
    CrossrefPubMedGoogle Scholar
  • 40 Zvizdic Z, Vranic S. Decreased number of acute appendicitis cases in pediatric population during the COVID-19 pandemic: any link?. J Pediatr Surg 2021; 56 (01) 199-200
    CrossrefPubMedGoogle Scholar
  • 41 Zampieri N. Effect of SARS-CoV-2 on the incidence of appendicitis: the role of quarantine. Pediatr Emerg Care 2020; 36 (08) e482-e483
    CrossrefPubMedGoogle Scholar
  • 42 Zampieri N, Cinquetti M, Murri V, Camoglio FS. Incidence of appendicitis during SARS-CoV-2 pandemic quarantine: report of a single area experience. Minerva Pediatr 2020; DOI: 10.23736/S0026-4946.20.05901-0.
    CrossrefPubMedGoogle Scholar
  • 43 Montalva L, Haffreingue A, Ali L. et al. The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak. Pediatr Surg Int 2020; 36 (12) 1397-1405
    CrossrefPubMedGoogle Scholar
  • 44 La Pergola E, Sgrò A, Rebosio F. et al. Appendicitis in children in a large Italian COVID-19 pandemic area. Front Pediatr 2020; 8: 600320
    CrossrefPubMedGoogle Scholar
  • 45 Lee-Archer P, Blackall S, Campbell H, Boyd D, Patel B, McBride C. Increased incidence of complicated appendicitis during the COVID-19 pandemic. J Paediatr Child Health 2020; 56 (08) 1313-1314
    CrossrefPubMedGoogle Scholar
  • 46 Raffaele A, Cervone A, Ruffoli M. et al. Critical factors conditioning the management of appendicitis in children during COVID-19 Pandemic: experience from the outbreak area of Lombardy, Italy. Br J Surg 2020; 107 (11) e529-e530
    PubMedGoogle Scholar
  • 47 Kvasnovsky CL, Shi Y, Rich BS. et al. Limiting hospital resources for acute appendicitis in children: lessons learned from the U.S. epicenter of the COVID-19 pandemic. J Pediatr Surg. 2020 DOI: 10.1016/j.jpedsurg.2020.06.024
    CrossrefPubMedGoogle Scholar
  • 48 Maneck M, Günster C, Meyer HJ, Heidecke CD, Rolle U. Influence of COVID-19 confinement measures on appendectomies in Germany-a claims data analysis of 9797 patients. Langenbecks Arch Surg 2021; 406 (02) 385-391
    CrossrefPubMedGoogle Scholar
  • 49 Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health 2020; 4 (05) e10-e11
    Google Scholar
  • 50 Snapiri O, Rosenberg Danziger C, Krause I. et al. Delayed diagnosis of paediatric appendicitis during the COVID-19 pandemic. Acta Paediatr 2020; 109 (08) 1672-1676
    CrossrefPubMedGoogle Scholar
  • 51 Gerall CD, DeFazio JR, Kahan AM. et al. Delayed presentation and sub-optimal outcomes of pediatric patients with acute appendicitis during the COVID-19 pandemic. J Pediatr Surg. 2020 DOI: 10.1016/j.jpedsurg.2020.10.008
    CrossrefPubMedGoogle Scholar
  • 52 Fisher JC, Tomita SS, Ginsburg HB, Gordon A, Walker D, Kuenzler KA. Increase in pediatric perforated appendicitis in the New York City metropolitan region at the epicenter of the COVID-19 outbreak. Ann Surg 2021; 273 (03) 410-415
    CrossrefPubMedGoogle Scholar
  • 53 McPherson ML, Krennerich EC, Arrington AS, Sitler SG, Graf JM. Safe ground transport of pediatric COVID-19 patients-a single-center first-surge experience. Pediatr Emerg Care 2021; 37 (03) 175-178
    CrossrefPubMedGoogle Scholar
  • 54 Velayos M, Muñoz-Serrano AJ, Estefanía-Fernández K. et al. Influence of the coronavirus 2 (SARS-Cov-2) pandemic on acute appendicitis. An Pediatr (Engl Ed). 2020. DOI: 10.1016/j.anpede.2020.04.010
    CrossrefGoogle Scholar
  • 55 Gaitero Tristán J, Souto Romero H, Escalada Pellitero S. et al. Acute appendicitis in children during the COVID-19 pandemic: neither delayed diagnosis nor worse outcomes. Pediatr Emerg Care 2021; 37 (03) 185-190
    CrossrefPubMedGoogle Scholar
  • 56 Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 2000; 36 (01) 39-51
    CrossrefPubMedGoogle Scholar
  • 57 Narsule CK, Kahle EJ, Kim DS, Anderson AC, Luks FI. Effect of delay in presentation on rate of perforation in children with appendicitis. Am J Emerg Med 2011; 29 (08) 890-893
    CrossrefPubMedGoogle Scholar
  • 58 Cappendijk VC, Hazebroek FW. The impact of diagnostic delay on the course of acute appendicitis. Arch Dis Child 2000; 83 (01) 64-66
    CrossrefPubMedGoogle Scholar
  • 59 Sheath C, Abdelrahman M, MacCormick A, Chan D. Paediatric appendicitis during the COVID-19 pandemic. J Paediatr Child Health 2021; DOI: 10.1111/jpc.15359.
    CrossrefPubMedGoogle Scholar
  • 60 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 2021; DOI: 10.1055/s-0041-1723992.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 61 Meyer T. [Impact of the COVID-19 pandemic on appendicitis in COVID-19 negative children]. Monatsschr Kinderheilkd 2021; DOI: 10.1007/s00112-021-01161-5.
    CrossrefPubMedGoogle Scholar
  • 62 Saleem A, Sajid MI, Arshad M. Acute appendicitis during SARS-CoV-2: A brief communication of patients and changes in clinical practice from a single institute in Pakistan. J Pediatr Surg 2020; 55 (12) 2844-2845
    CrossrefPubMedGoogle Scholar
  • 63 Wulkan ML. Pediatric surgery in the time of COVID-19. J Laparoendosc Adv Surg Tech A 2020; 30 (04) 355
    CrossrefPubMedGoogle Scholar
  • 64 Polites SF, Azarow KS. Perspectives on pediatric appendicitis and appendectomy during the severe acute respiratory syndrome coronavirus 2 pandemic. J Laparoendosc Adv Surg Tech A 2020; 30 (04) 356-357
    CrossrefPubMedGoogle Scholar
  • 65 Davenport M, Pakarinen MP, Tam P, Laje P, Holcomb III GW. From the editors: the COVID-19 crisis and its implications for pediatric surgeons. J Pediatr Surg 2020; 55: 785-788
    CrossrefPubMedGoogle Scholar
  • 66 de Leeuw RA, Burger NB, Ceccaroni M. et al. COVID-19 and laparoscopic surgery: scoping review of current literature and local expertise. JMIR Public Health Surveill 2020; 6 (02) e18928
    CrossrefPubMedGoogle Scholar
  • 67 Ngaserin SH, Koh FH, Ong BC, Chew MH. COVID-19 not detected in peritoneal fluid: a case of laparoscopic appendicectomy for acute appendicitis in a COVID-19-infected patient. Langenbecks Arch Surg 2020; 405: 353-355
    CrossrefPubMedGoogle Scholar
  • 68 Jones BA, Slater BJ. Non-operative management of acute appendicitis in a pediatric patient with concomitant COVID-19 infection. J Pediatr Surg Case Rep 2020; 59: 101512
    CrossrefPubMedGoogle Scholar
  • 69 Svensson JF, Patkova B, Almström M. et al. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg 2015; 261 (01) 67-71
    CrossrefPubMedGoogle Scholar
  • 70 Lopez ME, Wesson DE. Medical treatment of pediatric appendicitis: are we there yet?. JAMA Pediatr 2017; 171 (05) 419-420
    CrossrefPubMedGoogle Scholar
  • 71 Minneci PC, Hade EM, Lawrence AE. et al; Midwest Pediatric Surgery Consortium. Association of nonoperative management using antibiotic therapy vs laparoscopic appendectomy with treatment success and disability days in children with uncomplicated appendicitis. JAMA 2020; 324 (06) 581-593
    CrossrefPubMedGoogle Scholar
  • 72 Lange B, Tenenbaum T, Wessel LM. [COVID-19 pandemic: management of pediatric surgical patients]. Monatsschr Kinderheilkd 2020; 1–5: 1-5
    PubMedGoogle Scholar
  • 73 Nasher O, Sutcliffe JR, Stewart RJ. Pediatric surgery during the COVID-19 pandemic: an international survey of current practice. Eur J Pediatr Surg 2020; DOI: 10.1055/s-0040-1714714.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 74 Ingram ME, Raval MV, Newton C, Lopez ME, Berman L. Characterization of initial North American pediatric surgical response to the COVID-19 pandemic. J Pediatr Surg 2020; 55 (08) 1431-1435
    CrossrefPubMedGoogle Scholar
  • 75 Ingram ME, Mehl S, Rentea RM. et al. Sharing strategies for safe delivery of surgical care for children in the COVID-19 Era. J Pediatr Surg 2021; 56 (01) 196-198
    CrossrefPubMedGoogle Scholar
  • 76 Truche P, Bowder A, Lalla AT. et al. Perspectives on perioperative management of children's surgical conditions during the COVID-19 pandemic in low-income and middle-income countries: a global survey. W J Pediatr Surg 2020; 3: e000187
    CrossrefPubMedGoogle Scholar
  • 77 Mazingi D, Ihediwa G, Ford K, Ademuyiwa AO, Lakhoo K. Mitigating the impact of COVID-19 on children's surgery in Africa. BMJ Glob Health 2020; 5 (06) e003016
    CrossrefPubMedGoogle Scholar
  • 78 Ogundele IO, Alakaloko FM, Nwokoro CC, Ameh EA. Early impact of COVID-19 pandemic on paediatric surgical practice in Nigeria: a national survey of paediatric surgeons. BMJ Paediatr Open 2020; 4 (01) e000732
    CrossrefPubMedGoogle Scholar
  • 79 Alsuwailem AB, Turkistani R, Alomari M. Complicated appendicitis in a pediatric patient with COVID-19: a case report. Cureus 2020; 12 (06) e8677
    PubMedGoogle Scholar
  • 80 Meyer JS, Robinson G, Moonah S. et al. Acute appendicitis in four children with SARS-CoV-2 infection. J Pediatr Surg Case Rep 2021; 64: 101734
    CrossrefPubMedGoogle Scholar
  • 81 Malhotra A, Sturgill M, Whitley-Williams P. et al. Pediatric COVID-19 and appendicitis: a gut reaction to SARS-CoV-2?. Pediatr Infect Dis J 2021; 40 (02) e49-e55
    CrossrefPubMedGoogle Scholar
  • 82 Jones VG, Mills M, Suarez D. et al. COVID-19 and Kawasaki disease: novel virus and novel case. Hosp Pediatr 2020; 10 (06) 537-540
    CrossrefPubMedGoogle Scholar
  • 83 Verdoni L, Mazza A, Gervasoni A. et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395 (10239): 1771-1778
    CrossrefPubMedGoogle Scholar
  • 84 Belhadjer Z, Méot M, Bajolle F. et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation 2020; 142 (05) 429-436
    CrossrefPubMedGoogle Scholar
  • 85 Toubiana J, Poirault C, Corsia A. et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ 2020; 369: m2094
    CrossrefPubMedGoogle Scholar
  • 86 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 (07) e19-e20
    CrossrefPubMedGoogle Scholar
  • 87 Harwood R, Partridge R, Minford J, Almond S. Paediatric abdominal pain in the time of COVID-19: a new diagnostic dilemma. J Surg Case Rep 2020; 2020 (09) rjaa337
    CrossrefPubMedGoogle Scholar
  • 88 Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395 (10237): 1607-1608
    CrossrefPubMedGoogle Scholar
  • 89 Miller J, Cantor A, Zachariah P, Ahn D, Martinez M, Margolis KG. Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children that is related to coronavirus disease 2019: a single center experience of 44 cases. Gastroenterology 2020; 159 (04) 1571-1574.e2
    CrossrefPubMedGoogle Scholar
  • 90 Whittaker E, Bamford A, Kenny J. et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324 (03) 259-269
    CrossrefPubMedGoogle Scholar
  • 91 Lishman J, Kohler C, de Vos C. et al. Acute appendicitis in multisystem inflammatory syndrome in children with COVID-19. Pediatr Infect Dis J 2020; 39 (12) e472-e473
    CrossrefPubMedGoogle Scholar
  • 92 Shahbaznejad L, Navaeifar MR, Abbaskhanian A, Hosseinzadeh F, Rahimzadeh G, Rezai MS. Clinical characteristics of 10 children with a pediatric inflammatory multisystem syndrome associated with COVID-19 in Iran. BMC Pediatr 2020; 20 (01) 513
    CrossrefPubMedGoogle Scholar
  • 93 Jackson RJ, Chavarria HD, Hacking SM. A case of multisystem inflammatory syndrome in children mimicking acute appendicitis in a COVID-19 pandemic area. Cureus 2020; 12 (09) e10722
    PubMedGoogle Scholar
  • 94 Suwanwongse K, Shabarek N. Pseudo-appendicitis in an adolescent with COVID-19. Cureus 2020; 12 (07) e9394
    PubMedGoogle Scholar
  • 95 Guanà R, Pagliara C, Delmonaco AG. et al. Multisystem inflammatory syndrome in SARS-CoV-2 infection mimicking acute appendicitis in children. Pediatr Neonatol 2021; 62 (01) 122-124
    CrossrefPubMedGoogle Scholar
  • 96 Ekbatani MS, Hassani SA, Tahernia L. et al. Atypical and novel presentations of coronavirus disease 2019: a case series of three children. Br J Biomed Sci 2021; 78 (01) 47-52
    CrossrefPubMedGoogle Scholar
  • 97 Aslan N, Yildizdas D, Sinanoglu MS. A pediatric COVID-19 case with suspected acute abdomen, hyperferritinemic sepsis and developing MIS-C and pancreatitis. Indian J Pediatr 2021; 88 (03) 288
    CrossrefPubMedGoogle Scholar
  • 98 Gerall CD, Duron VP, Griggs CL, Kabagambe SK, Maddocks AB, DeFazio JR. Multisystem inflammatory syndrome in children mimicking surgical pathologies: what surgeons need to know about MIS-C. Ann Surg 2021; 273 (04) e146-e148
    CrossrefPubMedGoogle Scholar
  • 99 Ni W, Yang X, Yang D. et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care 2020; 24 (01) 422
    CrossrefPubMedGoogle Scholar
  • 100 Harwood R, Allin B, Jones CE. et al; PIMS-TS National Consensus Management Study Group. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc Health 2021; 5 (02) 133-141
    CrossrefPubMedGoogle Scholar