Neonatal Appendicitis

Abstract

Neonatal appendicitis is an unusual finding with a high mortality rate that occurs in term or preterm newborns. An uncomplicated debut is associated with delayed interventions and diagnosis, resulting in increased mortality. We present a preterm female patient native to a central region of the highlands of Peru who was born at 33 weeks gestation with a birth weight of 1310 g. She was born by cesarean section due to fetal distress and premature detachment of the placenta. She spent four days under CPAP-type respiratory support, and in her first week of life, she was already breastfeeding. At nine days of age, she presented with vomiting, initially resembling dairy but then becoming bilious and like coffee grounds. Imaging studies excluded pyloric hypertrophy and abnormal intestinal transit but resulted in a referral to a tertiary pediatric hospital in Lima to rule out intestinal malrotation. The patient arrived stable at the pediatric hospital at 20 days of life. Imaging studies excluded intestinal malrotation but exhibited a slow intestinal transit. An exploratory surgical intervention scheduled for the fifth day after arrival had to be deferred due to thrombocytopenia and increased prothrombin time, although this condition promptly corrected itself in two days. Finally, a laparotomy at 29 days of age revealed an appendix with vascular congestion and peri-appendicitis. Neonatal appendicitis, in this case, had a recurrent clinical presentation with full recovery after appendectomy. The patient had recurrent signs of intestinal obstruction with alternating periods of clinical and laboratory stability. These recurrent or intermittent clinical manifestations of neonatal appendicitis can delay the diagnosis and contribute to increased mortality.