Clinical and morphological symptoms of gangrenous appendicitis in children with laboratory-confirmed novel coronavirus infection

Abstract

L.V. Feklisova1, I.M. Rasstrigina2, E.B. Olkhova2, I.S. Allakhverdiev2, E.E. Tselipanova1, S.I. Zavarokhin2 1M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow, Russian Federation 2St. Vladimir Children's City Clinical Hospital, Moscow, Russian Federation Over recent years, amid the novel coronavirus disease (COVID-19) pandemic the prevalence of appendicitis in children has increased. However, its morphological characteristics are not described completely. The article elucidates clinical and morphological features of gangrenous appendicitis in hospitalized children with laboratory-confirmed COVID-19 diagnosis. The authors present the clinical, laboratory, instrumental and morphological findings in schoolchildren with gangrenous appendicitis associated with SARS-CoV-2, confirmed by nasopharyngeal swab PCR-testing. The disease was characterized by an acute onset, rapid development of abdominal pain syndrome and typical inflammatory changes in the clinical blood analysis: moderate leukocytosis (15.6×109/l), pronounced neutrophilia (82.2%), and thrombocytopenia (103 to 144×109/l). All patients had echographic signs of inflammatory transformation of the appendix which was removed on the first day of hospitalization (the first day of the disease) by laparoscopic technique. The examination of the removed biomaterial revealed a tendency to thrombosis in the small vessels of the process and ulcerative changes accompanied by necrosis. There is a discussion of the relationship between the development of gangrenous appendicitis and the clinical course of COVID-19 infection. It is necessary to continue investigations, perform in-depth analysis of the factors causing pathological changes, and to clarify the role of SARS-CoV-2 disease with the aim of preventing the spread of COVID-19. Keywords: SARS-CoV-2, COVID-19, children, appendicitis, removal of the appendix, thrombosis, cytokine storm, microangiopathy, necrosis. For citation: Feklisova L.V., Rasstrigina I.M., Olkhova E.B. et al. Clinical and morphological symptoms of gangrenous appendicitis in children with laboratory-confirmed novel coronavirus infection. Russian Journal of Woman and Child Health. 2023;6(1):68–74 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-68-74.