- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03902262
Acute Abdomen in Kawasaki Disease
Acute Abdomen in Kawasaki Disease: Case Reports
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
CASE PRESENTATION Case 1 An 8 year-old male started 48 hrs prior to admission with abdominal pain in the right lower quadrant associated with vomiting and fever. The physical examination revealed discrete bilateral conjunctival hiperemia, right cervical adenomegaly, and severe abdominal pain in the right lower quadrant with a positive McBurney sign. Laboratory tests showed CBC: Hb 14.1 g/dl, WBC 13,800, NT 81%, LT 3%, Plt 383,000/μl. C-reactive protein 230.9 mg/dl, BNP 106.4 pg/ml (0-99). Abdominal ultrasound confirmed the diagnosis of appendicitis. A laparoscopic appendectomy was performed, and appendiceal distal enlargement with fibrinopurulent tissue was found. Twelve hours after surgery, the patient presented increased conjunctival hyperaemia, generalized rash as well as upper extremities edema and desquamation, meeting criteria for Kawasaki disease. Cardiological evaluation showed mild pericardial effusion (3mm), normal coronary arteries. Intravenous immunoglobulins (IVIG), aspirin and steroids were started with resolution of the fever, rash and the conjunctival erythema.
Case 2. A 6-year-old male started 15 days prior to admission with fever. He presented hands and feet edema and a generalized exantema. He was diagnosed with scarlet fever. The patient presented conjunctival hyperemia and cheilitis. On day 15 the patient had severe abdominal pain (right lower quadrant), and was hospitalized with the diagnosis of appendicitis. An appendicetomy was performed and two perforations of the appendix were found. Appendicitis was found (Figure 1). The patient persisted with fever and desquamation of perineal area, fingers and toes were added to the clinical picture. Laboratories reported blood count: Hb 13 g/dl, WBC 47,700/mm3 neutrophils 95% bands 8% platelets 551,000/μl, C-reactive protein 19.7 mg/dl, ESR 53 mm/hr, hypoalbuminemia 2.2 g/dl. Diagnosis of KD was established and IVIG 2 g/kg and aspirin were administered. Echocardiogram was normal. Surgical wound culture was reported positive for Enterococcus faecium and Escherchia coli. Antibiotic therapy was administered for 14 days with good evolution.
Case 3. A 5-year-old male patient, presented with a history of fever for 5 days diagnosed as bacterial tonsillitis and treated with antibiotics without resolution. On the fifth day the patient developed bilateral conjunctivitis, erythema on the lips, morbilliform exanthema in the anterior and posterior thorax and abdominal pain in mesogastrium and right lower cuadrant. His physical examination revealed non-purulent bilateral conjunctivitis, cracked lips, strawberry tongue, cervical lymphadenopathy of 0.5 x 1 cm, exanthema in thoracic and dorsal region, with significant erythema of palms and soles, without skin exfoliation. The patient presented with severe abdominal pain located in the right lower quadrant, with signs of peritoneal irritation. Abdominal ultrasound was performed and was suggestive of acute appendicitis. Laboratories reported blood count: Hb 14.1 g/dl, Hcto 40.5%, WBC 3400 /uL, neutrophils 3100/uL, lymphocytes 300 103/uL, platelets 41,000 103/uL; ferritin 1700 ng/ml, triglycerids 190 mg/dl, C-reactive protein 8 mg/dl, normal hepatic and renal function. A diagnosis of KD and acute appendicitis was made. Treatment was started with IVIG and aspirin. The boy was taken to diagnostic laparoscopy where periappendicular inflammation was found. The cecal appendix biopsy presented normal morphology up to the serous layer, with congestive vessels, interstitial edema, and mild inflammatory infiltrate with predominantly mononuclear cells within the lymphatic vessels (Figure 2). A final diagnosis of mild mononuclear periappendicitis was made. The patient had an uneventful evolution with resolution of the symptoms.
Study Type
Enrollment (Actual)
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients with Kawasaki disease.
- Acute abdomen requiring surgery.
Exclusion Criteria:
- Patients with chronic gastrointestinal disease.
- Incomplete data on the charts.
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Only
- Time Perspectives: Retrospective
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Kawasaki disease presenting with acute abdomen
Time Frame: Up to three weeks
|
Histopathological results of appendix
|
Up to three weeks
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Cardiovascular Diseases
- Vascular Diseases
- Skin Diseases
- Infections
- Lymphatic Diseases
- Pain
- Neurologic Manifestations
- Signs and Symptoms, Digestive
- Gastrointestinal Diseases
- Gastroenteritis
- Intestinal Diseases
- Vasculitis
- Skin Diseases, Vascular
- Cecal Diseases
- Intraabdominal Infections
- Abdominal Pain
- Appendicitis
- Abdomen, Acute
- Mucocutaneous Lymph Node Syndrome
Other Study ID Numbers
- 01-04-2019
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Appendicitis
-
University of MichiganCompletedAppendicitis | Complicated Appendicitis | Perforated Appendicitis | Ruptured AppendicitisUnited States
-
North Estonia Medical CentreTartu University HospitalRecruitingAcute Appendicitis | Appendicitis Acute | Appendicitis Perforated | Acute Appendicitis With Rupture | Appendicitis; Perforation | Acute Appendicitis Without Peritonitis | Acute Appendicitis With Appendix AbscessEstonia
-
HJ23Hospital Universitari Joan XXIII de Tarragona.Not yet recruitingAcute Appendicitis | Appendicitis Perforated | Appendicitis Suppurative
-
Azienda Socio Sanitaria Territoriale degli Spedali...CompletedAppendicitis | Appendicitis Acute | Appendiceal Abscess | Appendicolith | Appendicitis With Perforation | Appendicitis PeritonitisItaly
-
Phoenix Children's HospitalTerminatedComplicated Appendicitis | Perforated AppendicitisUnited States
-
Faculty Hospital Kralovske VinohradyCompletedAppendicitis | Appendicitis Acute | Retrocecal AppendicitisCzechia
-
Johns Hopkins All Children's HospitalRecruiting
-
Pirogov Russian National Research Medical UniversityCompletedAcute Appendicitis | Acute Appendicitis With Rupture | Acute Appendicitis Without Peritonitis | Acute Appendicitis With PeritonitisRussian Federation
-
Turku University HospitalOulu University Hospital; Kuopio University Hospital; Seinajoki Central Hospital and other collaboratorsNot yet recruitingUncomplicated Acute AppendicitisFinland
-
Hospital Universitario Virgen de la ArrixacaUnknownUncomplicated Acute AppendicitisSpain
Clinical Trials on appendicectomy
-
Princess Alexandra Hospital NHS TrustRecruitingCovid19 | Appendicitis AcuteUnited Kingdom
-
Tampere University HospitalCompleted
-
National Center for Gastroentestinal and Liver...CompletedGeneral SurgerySudan
-
University of ZurichUniversity of Athens; Laikο General Hospital, Athens; Kantonsspital MünsterlingenUnknownAbdominal Pain | Appendicitis | Abdominal SepsisSwitzerland
-
Pamela Youde Nethersole Eastern HospitalCompletedAcute AppendicitisChina
-
Kuopio University HospitalCompleted
-
University Hospital of SplitNot yet recruitingAppendix TumorCroatia
-
University of Auckland, New ZealandAuckland District Health BoardUnknownPeritoneal Dessication Damage and Inflammation | Peri-operative HypothermiaNew Zealand