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

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. </p

СОВРЕМЕННЫЕ МЕТОДЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ДЕСТРУКТИВНОЙ ПНЕВМОНИИ У ДЕТЕЙ

This article summarizes the clinical experience in diagnostics and treatment of destructive pneumonia in 258 children. The presented algorithm enables to make a timely diagnosis and provide necessary therapeutic aid including mini-invasive interventions to children with pulmonary and pleural complications of pneumonia. The single port thoracoscopy and ultrasound irrigation of the pleural cavity with the antibiotic-containing solution free the lung from fibrin coating, deliver the preparation to the focus of inflammation and remove the inflammatory exudate. Ultrasound screening used during treatment considerably expands the possibilities of pathology diagnostics and invasive methods of treatment.В статье обобщен клинический опыт диагностики и лечения деструктивной пневмонии у 258 детей. Представленный алгоритм позволяет своевременно диагностировать и оказывать необходимые лечебные пособия, включая мини-инвазивные вмешательства, детям с легочными и плевральными осложнениями течения пневмонии. Однопортовая торакоскопия с ультразвуковой санацией плевральной полости в растворе антибиотиков позволяет освободить легкое от налетов фибрина, доставить антибактериальный препарат к очагу воспаления, удалить воспалительный экссудат. Применяемый на этапах лечения ультразвуковой скрининг значительно расширяет возможности диагностики патологии и сопровождения инвазивных методов лечения

ЛАПАРОСКОПИЧЕСКИЕ ОПЕРАЦИ У ДЕТЕЙ С ПАТОЛОГИЕЙ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ

The article deals with the experience of laparoscopy in 33 children with defects and diseases of the pancreas. Initial experience accumulated by the authors proves that laporoscopies are still effective and low-trauma surgeries used in the correction of congenital and acquired diseases of the pancreas. The volume and technique of minimally invasive surgeries are determined by the type of pancreatic pathology, patients’ age and developed complications.В статье представлен опыт лапароскопических операций у 33 детей с пороками и заболеваниями поджелудочной железы. Накопленный авторами начальный опыт свидетельствует о том, что лапароскопические вмешательства остаются эффективными и малотравматичными операциями при коррекции врожденных и приобретенных заболеваний поджелудочной железы. Объем и техника мини-инвазивных вмешательств определяются видом патологии поджелудочной железы, возрастом больных и развившимися осложнениями

Pathogenetic mechanisms of destructive pneumonia in children. Case report with literature review

E.M. Tolstova1, M.V. Besedina1, O.V. Zaytseva1, N.S. Zaitseva1, S.B. Yatsyshina2, D.V. Khaspekov3, E.B. Olkhova1,3, I.V. Turishchev3, N.A. Sholokhova3,4, P.P. Galeev3, T.Yu. Belyaeva3 1A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation 2Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russian Federation 3St. Vladimir Children's City Clinical Hospital, Moscow, Russian Federation 4Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation Destructive pneumonia (DP) in children is a complication derived from community-acquired pneumonia, while parenchymal necrosis occurs in the pulmonary infiltration zone with the formation of multiple merging small cavities. The disease pathogenesis has not yet been precisely established. The factors predisposing to pulmonary destructive complications in pneumonia remain unknown. We present a case study of this disease in a 5-year-old female patient hospitalized in December 2022. Manifestation in the form of acute upper respiratory tract infection, subsequent deterioration with the progression of pneumonia and pleurisy indicate the importance of viral-bacterial interactions in the DP pathogenesis. Influenza A was confirmed in the laboratory, while Streptococcus pneumoniae was isolated in the fluid culture obtained during bronchoalveolar lavage. Using the example of the presented case, we discuss the mechanisms of DP pathogenesis in children from a modern perspective. The necessity of coagulology, a combination of radiology diagnostic methods (radiography, ultrasound, computed tomography) was justified. It is necessary to further study the pathogenetic mechanisms of the DP progression in order to optimize preventive and therapeutic rehabilitation measures in community-acquired pneumonia in children. Keywords: destructive pneumonia, necrotizing pneumonia, influenza A, Streptococcus pneumoniae, hypercoagulation. For citation: Tolstova E.M., Besedina M.V., Zaytseva O.V., Zaitseva N.S., Yatsyshina S.B., Khaspekov D.V., Olkhova E.B., Turishchev I.V., Sholokhova N.A., Galeev P.P., Belyaeva T.Yu. Pathogenetic mechanisms of destructive pneumonia in children. Case report with literature review. Russian Journal of Woman and Child Health. 2023;6(3):310–319 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-15. </p