Relationship between Kawasaki disease and abdominal pain

Abstract

This editorial presents an analysis of an article recently published in the World Journal of Clinical Cases. Kawasaki disease (KD) is a well-known pediatric vasculitis characterized by fever, rash, conjunctivitis, oral mucosal changes, and swelling of the extremities. This editorial aims to delve into the intricate relationship between KD and abdominal pain, drawing insights from recent research findings to provide a comprehensive understanding and potential avenues for future investigation.

Key Words: Kawasaki disease; Abdominal pain; Relationship; Research; Investigation

Core Tip: Abdominal pain in Kawasaki disease (KD), particularly in pediatric populations, may function as a potential indicator of complications, such as coronary artery aneurysms, thereby requiring increased clinical vigilance. The occurrence of KD in patients with fever and abdominal pain should be carefully monitored, and timely diagnosis and intervention are imperative for achieving favorable patient outcomes.

INTRODUCTION

Kawasaki disease (KD), initially described as a systemic inflammatory disorder affecting small- and medium-sized arteries, is characterized by fever, conjunctivitis, oral mucosal alterations, rashes, and extremity edema[1]. With advances in scientific inquiry, it is increasingly recognized that KD can affect various organ systems, with abdominal manifestations emerging as a significant aspect of the disease[2]. This editorial highlights the importance of recognizing KD in patients with fever, presenting with acute abdominal symptoms[3]. This unique and noteworthy presentation necessitates a more thorough investigation of the correlation between KD and abdominal pain. Studies have shown an increasing prevalence of abdominal pain among patients with KD, especially in younger patients. The etiology of abdominal pain in KD has not been fully elucidated; however, it may be linked to pathological cardiac changes, thrombosis, and systemic inflammation[2].

CASE ANALYSIS

In the cases described above, patients exhibiting acute abdominal symptoms later developed significant coronary artery aneurysms (CAA), indicating a strong correlation between KD and abdominal pain[4]. Although CAA in KD are infrequent, they represent a serious complication that can potentially lead to abdominal pain via multiple pathways, and thrombus formation in aneurysms can result in local ischemia and subsequent abdominal pain. Additionally, compromised cardiac function caused by aneurysms may lead to congestive heart failure, resulting in hepatic congestion, ascites, and abdominal symptoms. Furthermore, the systemic inflammatory response in patients with KD can affect various organs, including the abdominal viscera, potentially contributing to abdominal pain. Therefore, in patients with KD, especially in the younger age groups, the presence of abdominal pain should prompt the consideration of potential CAA and related complications[5,6].

In such rare yet critical clinical scenarios, early diagnosis and intervention are crucial. The presented cases highlight the challenges in managing patients with KD with abdominal pain, emphasizing the need for a nuanced understanding and tailored therapeutic approaches. In this case, the patient underwent abdominal exploration and appendectomy, but persistent abdominal pain postoperatively led to the discovery of massive CAA. This underscores the importance of considering the possibility of aneurysms in patients with KD presenting with acute abdominal symptoms, particularly after surgery, necessitating further investigations for a definitive diagnosis. Surgical interventions in such cases pose unique challenges, primarily due to extensive intramural thrombus formation complicating the surgical procedure. The significant thrombus burden observed in this case makes coronary artery bypass grafting (CABG) a complex procedure. This underscores the importance of a thorough preoperative assessment of coronary artery involvement in patients with KD to guide individualized surgical strategies[7].

Although the present case exhibited a favorable postoperative outcome, challenges persist with CABG in patients with KD. A patient's young age poses heightened requirements for the heart and vessel size compatibility. Furthermore, the clinical features and impact of CAA on surgery warrant further investigation to refine surgical indications, techniques, and long-term prognosis. Future research should delve deeper into the indications, surgical techniques, and long-term outcomes of CABG in patients with KD, aiming to enhance treatment success and patient survival rates[8].

CONCLUSION

This study examined the correlation between KD and abdominal pain, offering a thorough analysis of the various clinical presentations of the disease[9-11]. The presence of abdominal pain in KD, particularly in pediatric patients, may signal the presence of serious complications such as CAA, underscoring the importance of increased vigilance in clinical practice. Timely diagnosis and intervention are imperative for achieving favorable patient outcomes. The occurrence of KD in patients with fever and abdominal pain should be carefully monitored, and the causes of abdominal pain should be understood in a follow-up study. An enhanced understanding of these mechanisms will inform healthcare providers regarding the development of more precise diagnostic and therapeutic approaches.