Page 218 - Abstract Book KONIKA 18

Gastroenterohepatology

P-GEH-016
Sonographically Undetected Appendicitis: A Case Report

Patricia Yulita Gunawan , Tirza Dian Patricia Lintang 2
1
Pediatrician, Faculty of Medicine, Universitas Pelita Harapan/ Siloam Hospitals Karawaci, Tangerang and
1
Radiologist, Anugerah Tomohon Hospital, North Sulawesi , Indonesia
2
Abstract
Background Appendicitis is the number one surgical emergency and one of the most common causes of
abdominal pain in children. Diagnosis delay increases the risk of rupture, resulting in peritonitis. Objective
To demonstrate an appendicitis case with atypical laboratory results and which was undetected with
ultrasonography. Case A 13-years-old obese boy complained of 4 days intermittent abdominal pain and 1
day shortness of breath. The pain was at the right lower quadrant (RLQ) at first, then spread to all abdominal
region, especially periumbilical. He was fully alert with fever, chest retraction, and positive McBurney sign.
Laboratory results showed increased segment neutrophil and ESR. Abdominal ultrasonography showed
free fluid collection in RLQ. Acid Fast Bacillus was not found from gastric lavage. Despite being treated
with ceftriaxone, the symptoms worsen. Abdominal CT on 6 day of treatment showed appendicolith with
th
unclear fat stranding around the appendix with significant amount of ascites predominantly in right region
of abdomen and perivesical, multiple mesenterial lymphadenopathy, and right pleural effusion. Laparotomy
was performed immediately, in which abscess pocket was found on the right subdiaphragmatic area near
the liver. The tissue histology showed perforated acute appendicitis. The patient’s condition improved after.
Conclusion Although considered as the first choice of imaging modalities to diagnose appendicitis in children,
ultrasonography may produce false-negative results in retrocecal or aberrant positions of appendices, in
perforated appendices, and in obese patients, in addition to its operator-dependent nature. A more accurate
modality should be considered to confirm the diagnosis in patients with non-visualized appendices.
Keywords: appendicitis; ultrasonography; adolescent; peritonitis

P-GEH-017
Infantile Amebiasis and Coronavirus Disease 2019 (COVID-19) Infection:
A Case Report

Prabandari Kusumaningtyas, Budiyanto, Choirul Anam
Department of Child Health, Faculty of Medicine Universitas Lambung Mangkurat/Ulin General Hospital,
Banjarmasin, South Borneo, Indonesia

Abstract
Background The COVID-19 pandemic has caused tremendous health issues. Several children with COVID-19
have reported gastrointestinal manifestations, such as nausea, vomiting, diarrhea, and abdominal pain. There
have been only few case reports of COVID-19 manifesting with bloody diarrhea. Bloody diarrhea was
considered a classic symptom in intestinal amebiasis. Amebiasis is very endemic in developing countries,
especially in tropical and subtropical countries such as Indonesia. Objective To describe coinfection infantile
amebiasis and COVID-19 in a child that might result in misdiagnosis and to ensure inadequate treatment.
Case A 3-months-old girl complained of fever, vomiting, and bloody diarrhea. On physical examination, we
found unremarkable result. From laboratory data shown positive result for the SARS-CoV-2 PCR test and
from direct stool examination showed Entamoeba histolytica cysts and trophozoites with erythrocytes and
leukocytes. This simple laboratory test should be conducted in COVID-19 cases presenting with atypical
bloody diarrhea. In COVID-19, gastrointestinal manifestation could be caused either by direct viral invasion
and/or angiotensin-converting enzyme 2 receptor and transmembrane serine protease (TMPRSS2) expression,
facilitating the cell entry of the virus. Specific treatment using metronidazole particularly for targeting the
trophozoite stage. Zinc was given because its ability to reduce the duration and severity of acute diarrhea
and has direct and indirect antiviral properties. Multivitamin was also given such as vitamin C and D as
supportive therapy for COVID-19. Conclusion A correct and detailed diagnosis is essential to increase the
patient’s survival rate, particularly in this COVID-19 pandemic where coinfections may occur due to possible
immune system deterioration.
Keywords: intestinal amebiasis; bloody diarrhea; COVID-19

170 KONIKA XVIII Abstract Book