Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19
Purpose: Various manifestations of coronavirus (SARS-CoV-2) have been reported since the pandemic began. Some articles have reported acute pancreatitis in adult patients due to COVID-19 infection. To our knowledge this is the first report of acute hemorrhagic necrotizing pancreatitis in children ass...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-07-01
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| Series: | Journal of Pediatric Surgery Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213576622001166 |
| _version_ | 1811341103351201792 |
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| author | Petra Zahradníková René Jáger Rebeka Pechanová Lenka Fedorová Igor Béder Dominika Barloková Barbora Nedomová Peter Švajdler Jozef Babala |
| author_facet | Petra Zahradníková René Jáger Rebeka Pechanová Lenka Fedorová Igor Béder Dominika Barloková Barbora Nedomová Peter Švajdler Jozef Babala |
| author_sort | Petra Zahradníková |
| collection | DOAJ |
| description | Purpose: Various manifestations of coronavirus (SARS-CoV-2) have been reported since the pandemic began. Some articles have reported acute pancreatitis in adult patients due to COVID-19 infection. To our knowledge this is the first report of acute hemorrhagic necrotizing pancreatitis in children associated with SARS-CoV-2 infection. Case presentation: A 7-year-old girl with congenital immunodeficiency was referred to the intensive care (ICU) unit with acute respiratory distress syndrome. She required mechanical ventilation (MV) due to pulmonary involvement of COVID-19 (chest CT with lower lung ground-glass opacities). SARS-CoV-2 infection was laboratory confirmed. Following a 49-day stay in the ICU, due to the clinical and radiological signs of acute abdomen and to the rapid deterioration in the clinical status, an indication to proceed an urgent surgerical intervention was made. Intra-operatively an adhesiolysis with blunt dissection of the of gastrocolic ligament was performed, then followed by debridement of the necrotic pancreas (more than 1⁄2 of the pancreas was damaged). Continuous lavage and drainage were placed. During the post-operative period, patient required aggressive MV and insulin therapy for persistent hyperglycemia. The CT scans reported a necrosis of the pancreas and we observed amylase and lipase elevation in the peritoneal lavage sample. Despite active intensive therapy, the patient's condition did not improve and she died 38 days after laparotomy as a result of multi-organ failure. Conclusion: The mechanism for the development of acute haemorrhagic necrotizing pancreatitis in the COVID-19 positive patients is unclear; perhaps it is due to a direct cytopathic effect from the COVID-19 virus, or due to the ACE2 expression in pancreas. |
| first_indexed | 2024-04-13T18:51:44Z |
| format | Article |
| id | doaj.art-6624322f005f474dacf41ee263d4c2a9 |
| institution | Directory Open Access Journal |
| issn | 2213-5766 |
| language | English |
| last_indexed | 2024-04-13T18:51:44Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Case Reports |
| spelling | doaj.art-6624322f005f474dacf41ee263d4c2a92022-12-22T02:34:23ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662022-07-0182102289Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19Petra Zahradníková0René Jáger1Rebeka Pechanová2Lenka Fedorová3Igor Béder4Dominika Barloková5Barbora Nedomová6Peter Švajdler7Jozef Babala8Department of Paediatric Surgery, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia; Corresponding author.Department of Paediatric Surgery, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, SlovakiaDepartment of Paediatric Surgery, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, SlovakiaDepartment of Paediatric Surgery, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, SlovakiaDepartment of Paediatric Surgery, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, SlovakiaDepartment of Paediatric Surgery, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, SlovakiaDepartment of Paediatric Anaesthesiology and Intensive Medicine, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, SlovakiaDepartment of Pathology, Charles University in Prague, Faculty of Medicine in Pilsen, Pilsen, Czech RepublicDepartment of Paediatric Surgery, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, SlovakiaPurpose: Various manifestations of coronavirus (SARS-CoV-2) have been reported since the pandemic began. Some articles have reported acute pancreatitis in adult patients due to COVID-19 infection. To our knowledge this is the first report of acute hemorrhagic necrotizing pancreatitis in children associated with SARS-CoV-2 infection. Case presentation: A 7-year-old girl with congenital immunodeficiency was referred to the intensive care (ICU) unit with acute respiratory distress syndrome. She required mechanical ventilation (MV) due to pulmonary involvement of COVID-19 (chest CT with lower lung ground-glass opacities). SARS-CoV-2 infection was laboratory confirmed. Following a 49-day stay in the ICU, due to the clinical and radiological signs of acute abdomen and to the rapid deterioration in the clinical status, an indication to proceed an urgent surgerical intervention was made. Intra-operatively an adhesiolysis with blunt dissection of the of gastrocolic ligament was performed, then followed by debridement of the necrotic pancreas (more than 1⁄2 of the pancreas was damaged). Continuous lavage and drainage were placed. During the post-operative period, patient required aggressive MV and insulin therapy for persistent hyperglycemia. The CT scans reported a necrosis of the pancreas and we observed amylase and lipase elevation in the peritoneal lavage sample. Despite active intensive therapy, the patient's condition did not improve and she died 38 days after laparotomy as a result of multi-organ failure. Conclusion: The mechanism for the development of acute haemorrhagic necrotizing pancreatitis in the COVID-19 positive patients is unclear; perhaps it is due to a direct cytopathic effect from the COVID-19 virus, or due to the ACE2 expression in pancreas.http://www.sciencedirect.com/science/article/pii/S2213576622001166SARS-CoV-2Necrotising pancreatitisCOVID-19 |
| spellingShingle | Petra Zahradníková René Jáger Rebeka Pechanová Lenka Fedorová Igor Béder Dominika Barloková Barbora Nedomová Peter Švajdler Jozef Babala Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19 Journal of Pediatric Surgery Case Reports SARS-CoV-2 Necrotising pancreatitis COVID-19 |
| title | Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19 |
| title_full | Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19 |
| title_fullStr | Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19 |
| title_full_unstemmed | Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19 |
| title_short | Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19 |
| title_sort | lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and covid 19 |
| topic | SARS-CoV-2 Necrotising pancreatitis COVID-19 |
| url | http://www.sciencedirect.com/science/article/pii/S2213576622001166 |
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