key: cord-0691645-u6djampj
authors: Khesrani, Lamia Sabrina; Chana, karima; Sadar, Fatma Zohra; Dahdouh, Abdelkader; Ladjadj, Yasmina; Bouguermouh, Dania
title: Intestinal ischemia secondary to Covid-19
date: 2020-08-20
journal: J Pediatr Surg Case Rep
DOI: 10.1016/j.epsc.2020.101604
sha: 04b8e1099478e75ef0816ccc98aa8b79988ee04c
doc_id: 691645
cord_uid: u6djampj

With the wide spread of the current SARS-Cov (Covid-19), It was found that about 2% of children was affected according to several studies, it should be mentioned that Those children are most often asymptomatic, but the current concern is about a vascular inflammatory disease which is similar to Kawasaki disease observed in children with Covid-19. we report a case of a 9-year-old girl, known to have idiopathic medullar aplasia, admitted to the emergency department for a pseudo appendicular syndrome with shock, neurological abnormalities and skin lesions. She underwent an emergency surgery; the peroperative exploration suggested an ischemic bowel lesion of the ileal loop and a healthy appendix. The link involving a Covid-19 infection was well established (RT-PCR +). We shared in common our clinical, radiological, biological and pathological data to draw attention towards the intestinal vasculitis that can be a part in the MIS-C related to Covid 19. To our best knowledge, this is the first case encountered of combination between Covid-19 with intestinal ischemic in children.

1. The manuscript must be edited by an English language professional : done 2. Edit title to: "Intestinal ischemia secondary to Covid-19": done J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f we report a case of an Algerian girl underwent an emergency surgery for a pseudo appendicular syndrome associated with multisystemic impairment (MIS-C) in an immunosuppressed child.

it's all about a case of a 09-year-old-girl with a medical history of idiopathic medullar aplasia diagnosed at the age of 3 and was on corticosteroids for one year (5 mg/day, 1day out of 2 on alternate days) who was examined at the surgical emergency department for a febrile pain of the right iliac fossa which was appeared one day before. It was accompanied by vomiting and diarrhea. Clinical examination of the child determined that the patient was scored 15 based on Glasgow score, the weight was 50 kg (BMI 26.6) with a temperature of 40°c. The abdomen examination findings determined tenderness of the right iliac fossa.

Laboratory findings were as follows: WBC:1140/uL. HGB:7g /dl. Platelet: 4000 uL. CRP :240mg/l

The abdominal-pelvic ultrasound findings monitored a swollen appendix with a densification of the mesenteric fat with a transonor liquid of medium abundance.

The first decision was considered, to correct and fix the hematological disorders and to combine antibiotics and analgesics. Both Chest X-ray and thoracic CT-scan showed suggested a ground glass opacities in left lung, pleural effusion of small abundance (figure 2). A brain CT scan: was normal and thus we ended up with an acute appendicular syndrome with shock, neurological signs, skin lesions, respiratory alkalosis and lung lesions. The MIS-C syndrome related to the Covid-19 viral Infection has been evoked on a medullary aplasia.

on account of the worsening of the child's condition and the accentuation of abdominal pain, the operative decision was performed Via right para-median incision, the exploration finds a sero-thematic liquid of average abundance, ischemic ileal lesions on 25 cm to 20 cm from the ileocecal crossroads ( figure 3) and a healthy meso-coeliac appendix (figure 4)

Resection of the ischemic loop with double ileostomy is performed.

Post operatively, immunoglobulins then corticoids are administered according to a treatment guideline in addition to antibiotics (cephalosporins + metronidazole + aminosides + azithromycin).

The cyto-bacteriological study of the peritoneal fluid was 100% lymphocytic.

The RT-PCR of the nasopharyngeal swab was positive. J o u r n a l P r e -p r o o f

The digestive disorders related to direct involvement of the virus are rare: diarrhea 6.6%, vomiting 5.8%. [2] All through this pandemic, a multi-systemic inflammatory syndrome (MIS-C) was reported for the first time by jones VG (USA) on April 7, 2020: a 6-month-old infant with Kawasaki disease related to a positive

Covid-19 test [ 3] . Since then, other cases have been reported related to covid-19 and suggesting a postviral immune response.

On May 06 th , 2020: Righagen (UK) [ The clinical data was most often intense with fever for over 4 days, with constant vasoplegic shock. Acute abdomen and the pseudo appendicular syndrome was reported by Toubiana:

Three cases in which one of them under abdominal surgery reveling an aseptic peritonitis.

Our patient presents similar symptoms to the cases described with fever, multi organ involvement, intense inflammatory syndrome, intestinal ischemia and a positive screening test of Covid 19.

Our observation is the first case reported with such ischemic lesions complicating the MIS-C syndrome and thus reinforcing the hypothesis of intestinal vasculitis.

An abdominal CT angio-scan would be useful to carry out a lesion assessment, to visualize a possible thrombus and to discuss a medical treatment, our patient had advanced lesions of ischemia and necrosis sites that's why the surgical excision was necessary;

Despite the management of the different disorders that appeared; the evolution was fatal in a multi visceral failure. is medullar aplasia an aggravating factor of MIS-C associated to Covid 19?

The digestive disorders and the pseudo appendicular symptoms are almost constant and at the forefront in the 

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