{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:16:51Z","timestamp":1760235411982,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: multisystem inflammatory syndrome in children (MIS-C) is a new disease associated with a recent infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Affected children can present predominantly with abdominal symptoms, fever and high inflammatory parameters that might lead to a consult by the pediatric surgeon and an indication for surgery. Methods: clinical data of three patients with MIS-C that underwent surgery were collected. Histopathological analysis of the appendix was performed. Results: we present the clinical course of three children with fever, abdominal pain and vomiting for several days. Clinical examination and highly elevated inflammation markers led to indication for laparoscopy; appendectomy was performed in two patients. Because of intraoperative findings or due to lack of postoperative improvement, all patients were reevaluated and tested positive for MIS-C associated laboratory parameters and were subsequently treated with corticosteroids, intravenous immunoglobulins, acetyl salicylic acid and\/or light molecular weight heparin. Conclusions: we discuss the implications of MIS-C as a new differential diagnosis and stress the importance of assessing the previous medical history, identifying patterns of symptoms and critically surveilling the clinical course. We implemented an algorithm for pediatric surgeons to consider MIS-C as a differential diagnosis for acute abdomen that can be integrated into the surgical workflow.<\/jats:p>","DOI":"10.3390\/children8080712","type":"journal-article","created":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T09:58:06Z","timestamp":1629367086000},"page":"712","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations"],"prefix":"10.3390","volume":"8","author":[{"given":"Nora","family":"Manz","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, University Children\u2019s Hospital Basel, 4056 Basel, Switzerland"},{"name":"Department of Clinical Research, University of Basel, 4056 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"H\u00f6fele-Behrendt","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Children\u2019s Hospital Basel, 4056 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Bielicki","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Children\u2019s Hospital Basel, 4056 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Children\u2019s Hospital Basel, 4056 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias S.","family":"Matter","sequence":"additional","affiliation":[{"name":"Institute of Medical Genetics and Pathology, University Hospital of Basel, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Bielicki","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Children\u2019s Hospital Basel, 4056 Basel, Switzerland"},{"name":"Department of Clinical Research, University of Basel, 4056 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Holland-Cunz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Children\u2019s Hospital Basel, 4056 Basel, Switzerland"},{"name":"Department of Clinical Research, University of Basel, 4056 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2213-4993","authenticated-orcid":false,"given":"Stephanie J.","family":"Gros","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Children\u2019s Hospital Basel, 4056 Basel, Switzerland"},{"name":"Department of Clinical Research, University of Basel, 4056 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/S0140-6736(20)31094-1","article-title":"Hyperinflammatory shock in children during COVID-19 pandemic","volume":"395","author":"Riphagen","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1016\/S0140-6736(20)31103-X","article-title":"An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: An observational cohort study","volume":"395","author":"Verdoni","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e20201711","DOI":"10.1542\/peds.2020-1711","article-title":"SARS-CoV-2-Induced Kawasaki-Like Hyperinflammatory Syndrome: A Novel COVID Phenotype in Children","volume":"146","author":"Licciardi","year":"2020","journal-title":"Pediatrics"},{"key":"ref_4","unstructured":"(2021, February 22). Coronavirus Disease 2019 (COVID-19): Epidemiology Update. Available online: https:\/\/health-infobase.canada.ca\/COVID-19\/epidemiological-summary-COVID-19-cases.html."},{"key":"ref_5","unstructured":"European Centre for Disease Prevention and Control (2021, February 22). COVID-19 Situation Dashboard. Available online: https:\/\/qap.ecdc.europa.eu\/public\/extensions\/COVID-19\/COVID-19.html#global-overview-tab."},{"key":"ref_6","unstructured":"The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (2020). The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi, 41, 145\u2013151."},{"key":"ref_7","unstructured":"Pakistan Cases Details (2021, February 22). COVID-19 Dashboard, Available online: https:\/\/covid.gov.pk\/stats\/pakistan."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1056\/NEJMoa2021680","article-title":"Multisystem Inflammatory Syndrome in U.S. Children and Adolescents","volume":"383","author":"Feldstein","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2001010","DOI":"10.2807\/1560-7917.ES.2020.25.22.2001010","article-title":"SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020","volume":"25","author":"Belot","year":"2020","journal-title":"Eurosurveillance"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e276","DOI":"10.1016\/S1473-3099(20)30651-4","article-title":"COVID-19 and multisystem inflammatory syndrome in children and adolescents","volume":"20","author":"Jiang","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.ajem.2021.05.076","article-title":"Multisystem inflammatory syndrome in children with COVID-19","volume":"49","author":"Gottlieb","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jpeds.2020.08.003","article-title":"Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review","volume":"226","author":"Abrams","year":"2020","journal-title":"J. Pediatrics"},{"key":"ref_13","first-page":"51","article-title":"Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation","volume":"38","author":"Radia","year":"2020","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1002\/art.41454","article-title":"American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS\u2013CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1","volume":"72","author":"Henderson","year":"2020","journal-title":"Arthritis Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e340","DOI":"10.1097\/INF.0000000000002888","article-title":"A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection","volume":"39","author":"Kaushik","year":"2020","journal-title":"Pediatric Infect. Dis. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1093\/jpids\/piaa112","article-title":"The Natural History of SARS-CoV-2 Related Multisystem Inflammatory Syndrome in Children (MIS-C): A Systematic Review","volume":"9","author":"Aronoff","year":"2020","journal-title":"J. Pediatric Infect. Dis. Soc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1001\/jama.2020.10369","article-title":"Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2","volume":"324","author":"Whittaker","year":"2020","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1001\/jama.2020.10374","article-title":"Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City","volume":"324","author":"Cheung","year":"2020","journal-title":"JAMA"},{"key":"ref_19","unstructured":"World Health Organization (2021, April 23). Multisystem Inflammatory Syndrome in Children and Adolescents Temporally Related to COVID-19. Available online: https:\/\/www.who.int\/news-room\/commentaries\/detail\/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-COVID-19."},{"key":"ref_20","unstructured":"Centers for Disease Control and Prevention (2021, April 23). Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19), Available online: https:\/\/www.cdc.gov\/mis-c\/hcp\/."},{"key":"ref_21","unstructured":"Royal College of Pediatrics and Child Health (2021, April 23). Guidance: Paediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19. Available online: https:\/\/www.rcpch.ac.uk\/resources\/paediatric-multisystem-inflammatory-syndrome-temporally-associated-COVID-19-pims-guidance."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1097\/INF.0000000000002967","article-title":"Abdominal Imaging Findings in Critically Ill Children With Multisystem Inflammatory Syndrome Associated With COVID-19","volume":"40","author":"Morparia","year":"2021","journal-title":"Pediatric Infect. Dis. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101838","DOI":"10.1016\/j.epsc.2021.101838","article-title":"Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID 19 era","volume":"69","author":"Valitutti","year":"2021","journal-title":"J. Pediatric Surg. Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101913","DOI":"10.1016\/j.epsc.2021.101913","article-title":"COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) presenting as appendicitis with shock","volume":"71","author":"Anderson","year":"2021","journal-title":"J. Pediatric Surg. Case Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e472","DOI":"10.1097\/INF.0000000000002900","article-title":"Acute Appendicitis in Multisystem Inflammatory Syndrome in Children With COVID-19","volume":"39","author":"Lishman","year":"2020","journal-title":"Pediatric Infect. Dis. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s00383-013-3439-9","article-title":"Appendicitis as the presenting manifestation of Kawasaki disease","volume":"30","author":"Garnett","year":"2014","journal-title":"Pediatric Surg. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.jpeds.2004.01.060","article-title":"Kawasaki disease mimicking an acute appendicitis","volume":"144","year":"2004","journal-title":"J. Pediatric"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"rjaa337","DOI":"10.1093\/jscr\/rjaa337","article-title":"Paediatric abdominal pain in the time of COVID-19: A new diagnostic dilemma","volume":"2020","author":"Harwood","year":"2020","journal-title":"J. Surg. Case Rep."},{"key":"ref_29","first-page":"e10722","article-title":"A Case of Multisystem Inflammatory Syndrome in Children Mimicking Acute Appendicitis in a COVID-19 Pandemic Area","volume":"12","author":"Jackson","year":"2020","journal-title":"Cureus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1097\/SLA.0000000000004368","article-title":"Multisystem Inflammatory Syndrome in Children Mimicking Surgical Pathologies: What Surgeons Need to Know about MIS-C","volume":"273","author":"Gerall","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101734","DOI":"10.1016\/j.epsc.2020.101734","article-title":"Acute appendicitis in four children with SARS-CoV-2 infection","volume":"64","author":"Meyer","year":"2021","journal-title":"J. Pediatric Surg. Case Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"101604","DOI":"10.1016\/j.epsc.2020.101604","article-title":"Intestinal ischemia secondary to COVID-19","volume":"61","author":"Khesrani","year":"2020","journal-title":"J. Pediatric Surg. Case Rep."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/8\/712\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:47:26Z","timestamp":1760165246000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/8\/712"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,19]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["children8080712"],"URL":"https:\/\/doi.org\/10.3390\/children8080712","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2021,8,19]]}}}