Title: 73 Abdominal pain in post-COVID 19 pediatric patients
Abstract: <h3></h3> The coronavirus pandemic first broke in December 2019. Unlike adults, children have been reported to present with milder clinical manifestations of the virus, sometimes even acting as asymptomatic carriers of infection. However, as early as mid-2020, pediatric patients who developed multisystem inflammatory syndrome (MIS-C), along with fever, cardiorespiratory symptoms and neurocognitive problems, were found to exhibit marked gastrointestinal (GI) manifestations, sometimes confounding diagnosis by mimicking GI infections, inflammatory bowel disease (IBD) or surgical contitions, such as acute appendicitis. We present series of cases of the school age children, who presented with severe abdominal pain during Bulgaria's first peak of COVID-19 pandemic. Characteristic symptoms of the disease – disosmia, nausea, vomiting, loss of appetite were reported to occur 2 weeks prior to hospitalization and were only mild or barely causing any concern to the parent. Children were admitted with symptoms of mild to moderate dehydration, metabolic acidosis and often constipation. The classical laboratory findings of elevated inflammatory response, leucopenia and lymphopenia were absent. Abdominal ultrasound was negative. Repeated surgical exams revealed no signs of acute abdomen. Qualitative antibody testing showed either presence of both IgM and IgG antibodies against SARS CoV-2 or only IgG antibodies. Some children had pathologic urinary findings, such as hematuria. Signs of autonomic dysfunction were observed since all of the patients had bradycardia and variations of blood pressure. No respiratory symptoms were registered and no children Had no history of pre-existing conditions. Symptomatic medication was effective only in some patients. Empiric AB-treatment proved to be much more successful, though no causative agent of intestinal infection was isolated. Manifestations of post-infectious MIS-C, associated with COVID-19 often include gastro-intestinal symptoms. For definitive diagnosis of the condition, tests for COVID-19 should be administered, since not all laboratory findings might be consistent with case definitions.