Clinical, laboratory, instrumental and morphological features of gangrenous and phlegmonous appendicitis in patients with COVID-19 infection
Authors:   M.F.Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russian Federation, L.V.Feklisova L.V.Feklisova , E.B.Olkhova E.B.Olkhova ,   A.I.Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation,   Children’s State Hospital of Saint Vladimir, Moscow, Russian Federation, I.M.Rasstrigina I.M.Rasstrigina ,   Children’s State Hospital of Saint Vladimir, Moscow, Russian Federation, I.S.Allakhverdiev I.S.Allakhverdiev ,   Children’s State Hospital of Saint Vladimir, Moscow, Russian Federation, V.N.Morozova V.N.Morozova ,   Children’s State Hospital of Saint Vladimir, Moscow, Russian Federation, S.A.Mikheeva S.A.Mikheeva ,   Children’s State Hospital of Saint Vladimir, Moscow, Russian Federation, N.G.Kireeva N.G.Kireeva ,   Children’s State Hospital of Saint Vladimir, Moscow, Russian Federation, S.V.Nikolaeva S.V.Nikolaeva ,   Central Research Institute of Epidemiology, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation, M.K.Khadisova M.K.Khadisova ,   M.F.Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russian Federation, A.V.Gorelov A.V.Gorelov ,   Central Research Institute of Epidemiology, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation
Published: December 2023

Objective. To present clinical, laboratory, instrumental and morphological features of phlegmonous and gangrenous appendicitis in patients with COVID-19 infection. Patients and methods. During the period from March 2020 to August 2022, 23 patients were observed with positive results of testing of nasopharyngeal sample for SARS-CoV-2 RNA and performed appendectomy. The age group of children is 8–17 years old (the average age is 14.1 years), there were 13 boys, 10 girls. The premorbid state is not burdened. The rationale for appendectomy was: acute abdominal pain, local soreness on the right side of the abdomen, their preservation until the surgical removal of the appendix and their disappearance after surgery. During ultrasound of the abdominal cavity, all patients had ECHO signs of inflammatory transformation of the vermiform process. The disease was accompanied by repeated vomiting on the background of subfebrile (13 children) or normal temperature (10 children). Respiratory syndrome is poor, 4 children had abdominal pain, 9 children had hyperemia of the pharynx, chest CT did not reveal inflammatory changes. Repeated virological examination showed the positive result in 3 of 9 examined; EIA for IgM and IgG detection was positive in 7 (out of 7 examined) with diagnostic titers in 3 patients. During histological examination, the length of the removed appendixes is ~8.1 cm (4–12.5 cm), partial or complete desquamation of the epithelium, massive infiltration by lymphocytes or neutrophils, circulatory disorders, in some cases (gangrenous appendicitis) – the phenomena of thrombosis of small vessels, mesenteriolitis, periappendicitis. Typical E. Coli was found in 4 out of 23 abdominal fluid samples. Conclusion. The complex of clinical, laboratory, instrumental and morphological data confirmed the diagnosis of appendicitis and the course of COVID-19, indicating the need for surgical intervention and the appointment of antiviral therapy, noting the need to continue the study. Key words: phlegmonous, gangrenous appendicitis, children, laparoscopic removal, ultrasound of abdomen, morphological examination of the appendix