In my ED, we have noted an increased number of children with perforated appendicitis during the COVID-19 pandemic. Is there a relationship between COVID-19 and acute appendicitis in children?-AM, SACRAMENTO, CALIF.
Mary Koloamatangi, Asia Le-Madison, RN, and Bridget Parsh, EdD, RN, CNS, respond-Appendicitis is one of the most common causes of abdominal pain in children and should be diagnosed quickly to avoid the risk of perforation.1,2 Lack of a detailed health history and an inadequate physical assessment can lead to an incorrect diagnosis, delayed treatment, and perforation.3
The incidence of appendicitis with perforation has increased during the COVID-19 pandemic. Although the exact reasons for this increase are unknown, research suggests that it may be due to delayed treatment as parents have hesitated to take their children to the hospital because of fears of contracting the virus.4-7
A New Jersey hospital saw an increase in patients with COVID-19 presenting with acute appendicitis on admission between March and July 2020.8 In a Virginia hospital, appendicitis diagnoses in the ED increased 30% with a threefold increase of perforation compared with cases in 2019.5 In an Israeli hospital, seven patients received a delayed diagnosis of appendicitis, which resulted in significant intra-abdominal complications.7 In a German study, the rate of perforation increased significantly, especially in younger and male patients.6 Most of these patients required prolonged hospitalization to treat the complications associated with the appendicitis.5,7
Signs and symptoms
Acute appendicitis may present with atypical signs and symptoms. Classic clinical manifestations in children include anorexia, right lower quadrant abdominal pain and tenderness, fever, diarrhea, and vomiting.4
Early recognition
Although more studies are needed, healthcare professionals should be aware of the possibility that gastrointestinal signs and symptoms mimicking appendicitis such as abdominal pain, vomiting, and diarrhea are common in some children with COVID-19. Testing for SARS-COV-2 in pediatric patients presenting to the hospital with severe gastrointestinal symptoms should be encouraged.4 Further studies are needed to provide insight into the correlation, if any, between COVID-19 and appendicitis.
REFERENCES