Perforated appendicitis in infancy

Abstract

Acute appendicitis is the major indication for abdominal surgery in the pediatric population. It represents 1–2% of all patients admitted into pediatric surgical wards. The clinical manifestations are varied and sometimes atypical due to the nature of the differing pathophysiology and the communicative capabilities of the patients based on age and development. We share a case of acute appendicitis that first presented to our emergency department and admitted under general pediatric medicine; later surgically treated and confirmed using histopathology. The patient's health record was reviewed for the following: demographics, visits, imaging modalities, management, outcome, and histopathology. Our 2-month-old patient was admitted under the general pediatric team who treated him at first under the assumption of incomplete Kawasaki disease. A consultation to pediatric surgery for an infected urachus lead to an Ultrasound and CT-scan studies being done. This was followed by exploratory laparotomy and appendectomy due to the need for drainage and further assessment. The findings which were further confirmed by histopathological specimens were suggestive of acute appendicitis with peri-appendiceal abscess Acute appendicitis in infants is a challenging diagnosis, A high level of suspicion and having knowledge of the red flags specific to abdominal pain and appendicitis in infants could significantly aid in improving diagnostic skills. In addition, early imaging using US in addition to CT is paramount in insuring early recognition and optimal outcomes