Intriguing Acute Abdomen and Covid-19 in children : A case report

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a worldwide pandemic, manifested commomly by infectious pneumonia, some patients also develop gastrointestinal (GI) and hepatic manifestations. To understand the clinical features and possible pathogenic mechanisms leading to gastrointestinal lesions in COVID-19 to formulate therapeutic strategy. Thus, we report the case of a girl with an acute febrile digestive picture revealing COVID19 infection, having direct contact with a COVIDpositive person. Surgical exploration was performed when white, on the balance sheet a PCR covid was negative and serology covid 19 (IgM positive and IgG positive). In conclusion, we are slowly starting to understand the complex pathogenesis of SARS-CoV-2 infections. The widespread organospecific complications of COVID-19, including those of the gastrointestinal system, are now increasingly appreciated. A thorough understanding of the gastrointestinal damage and clinical manifestations of this multi-organ disease remains imperative. Introduction Severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) is a global pandemic, manifested mainly by respiratory symptoms. An increasing number of extra-pulmonary symptoms and manifestations linked to COVID-19 have been observed, including gastrointestinal (GI) and hepatic manifestations. Very few adult case series have reported acute abdomen as a symptom of SARS-COV-2 infection.1 The objective of our work is to update physicians working with suspected cases of the Covid-19 on acute abdominal events. Case Report This is a 9-year-old head girl, with no significant past medical history, having direct contact with his mother who was covid positive two weeks before, admitted for an acute abdomen with shock. The history of the disease dates back to a week before its admission with fever over 39° C, complicated three days later by diffuse acute abdominal pain associated with watery diarrhea and vomiting post meals, without associated respiratory symptoms. The child was initially admitted in pediatric resuscitation in shock, on clinical examination she was drowsy with Glasgow 12/15, febrile at 39° C, capillary refill time above 3 seconds, tachycardia of 160 beats per minute, polypnea to 53 cycles per minute, 96% oxygen saturation in room air, blood pressure at 80 / 60mmg, severe abdominal pain generalized on palpation associated with contracture of the abdominal muscles, without hepatomegaly or splenomegaly. After the conditioning, an abdominal ultrasound was performed and showed a hypoecogenic ledure in favour of an intraperitoneal fluid effusion of medium abundance. Faced with this clinico-radiological picture, peritonitis was suspected but the surgical exploration carried out urgently, came back unremarkable. Biologically, we note the presence of a high crp, high ferritinémia, lymphopenia, as well as thrombocytopenia. More details are given in Table 1. Table 1. Hematological and Biochemical profile of the our patient Test Results Reference interval CRP 316 mg/l 0.0-5.0 Ferritin 1200 /mm3 15-200 Urea 1.05 g/l 0.13-0.43 Creatinine 26 mg/l 5.7-11.1