Title : Post Covid-19 Multi-System Inflammatory (MIS) syndrome masquerading as an acute abdomen a literature review and case series
Abstract:
Introduction: Recently a potentially fatal syndrome associated with COVID-19 infection termed multisystem inflammatory syndrome (MIS) has been described in adults (MIS-A). The syndrome presents weeks after recovery from the acute phase of the illness and is thought to be due to a dysregulated host immune response. Clinical features may include fever, abdominal pain, and localized abdominal peritonism. Therefore the syndrome can sometimes present like an acute surgical abdomen. 51% of MIS-A patients will require vasopressor support for shock, and the mortality rate is up to 7 %. Awareness of this condition by the surgical team, and early referral to the medical team for appropriate immunosuppressive therapy, can help prevent morbidity and mortality for these sometimes misdiagnosed patients.
Objectives: The primary objective of the study was to review the literature. Furthermore, we describe the presentation, investigation, and management of two cases that occurred at a single center.
Methods: The records of two cases of MIS-A that occurred at our health service were identified and reviewed. A literature search was conducted through the Ovid database with the keywords ‘MIS-A’ and ‘COVID-19’.
Results: MIS-A was diagnosed in two female patients (median age 30.5 years). Both patients presented with abdominal pain, fever, and localized abdominal tenderness. Computed tomography showed intestinal wall thickening (1/2) and mesenteric lymphadenopathy (2/2). Complications included ischemic changes on electrocardiogram (2/2), cardiogenic shock (1/2), and vasopressor requirement (1/2). The median length of admission was 11.5 days. Although rare the exact incidence of MIS-A is unknown.
Conclusion: General surgeons must have a high index of suspicion for MIS-A in a patient that has recently contracted COVID-19 and has presented like an acute abdomen.
