Neonatal Appendicitis Research Articles

Acute perforated appendicitis in a 15-day-old infant

Abstract Background Even though no age is free to be affected by appendicitis, it is extremely rare in newborn infants. Clinical presentations are usually nonspecific, abdominal imaging is not always diagnostic, and definitive diagnosis is difficult. We present a 15-day-old infant with acute perforated appendicitis that was diagnosed and treated in our pediatric center. Case report This case presented at Neonatal Intensive Care Unit with an 18-h-history of irritability, vomiting, and abdominal distension. With high white blood cell count and C-reactive protein level, the baby was initially diagnosed with neonatal sepsis. The ultrasound performed on day 3 after hospitalization found peritonitis but not seen appendicitis. Postoperative diagnosis confirmed acute perforated appendicitis with peritonitis. The baby was well covered without complication. Conclusion This case highlights that preoperative diagnosis of acute appendicitis in neonates is difficult due to nonspecific clinical presentation and the extreme rarity of the disease.

Neonatal Appendicitis with Cow Milk Protein Allergy

Appendicitis is rare in the neonatal period. A 6-week-old baby presented with fulminant appendicitis. At the age of 6 months, the infant was diagnosed with Cow milk protein allergy. Association between CMPA and appendicitis was a rare association in our case, showing that CMPA can have a wide spectrum of gastrointestinal involvement.

Perforated Neonatal Appendicitis with Massive Pneumoperitoneum: A Case Report

Neonatal appendicitis (NA) is a rare condition. It has a low incidence of 0.04-0.2% and is more common in premature male babies. NA should be considered in the differential diagnosis in cases when a newborn does not present with clinical signs of Hirschsprung's disease, Cystic Fibrosis and passes meconium normally. The causative etiology of neonatal perforated appendicitis (NPA) is a subject of debate and has not been elucidated. Although many etiologic theories exist, increasing evidence suggests a subset of NPA cases may represent a form of necrotizing enterocolitis (NEC) localized to the appendix. A 6 days old male-baby presented at the NICU with generalized abdominal tenderness, the patient was febrile, with tachycardia and mild respiratory distress. The X-ray showed massive pneumoperitoneum. Intraoperatively, perforated appendix was found and appendectomy was performed. The abdomen was washed with ample saline and closed in layers. Neonatal appendicitis usually presents with non-specific symptoms and signs. Because of its rarity and low index of suspicion, it poses a great diagnostic challenge pre-operatively.

An Experience with 31 Cases of Neonatal Appendicitis: A Retrospective Study

Background: Neonatal appendicitis (NA) is rarely diagnosed due to lack of specific symptoms and signs. The aim of this study is to share our experience with NA.Methods: We performed a retrospective data review from electronic medical records of patients admitted at Children’s Hospital of Chongqing Medical University (CHCMU) with the clinical diagnosis of NA from October 2001 to July 2018.Results: Of 31 neonates, male neonates (n=20) accounted for 64.5%. Abdominal distension and anorexia were the most common clinical features (61.3%, n=19). Neonates with elevated C- reactive protein (CRP) accounted for 92.6% (n=25) where as 51.6% (n=16) had normal white blood cell count (WBC). Of 29 neonates who underwent surgery, 69% (n=20) had perforated appendicitis.Conclusion: Neonatal appendicitis lacks specific clinical features, and early diagnosis is difficult. Clinicians need to have high index of suspicion when attending neonates with features of abdominal sepsis.

Colon stenosis due to acute neonatal appendicitis in a preterm baby: a case report

BackgroundColon stenosis and acute appendicitis are rare diseases among premature babies. To the best of our knowledge, no study has identified both the conditions in preterm babies.Case presentationHere we report a case of a preterm Japanese male baby who developed ascending colon stenosis and appendicitis. During his neonatal intensive care unit stay, he developed increasing apnea and vomiting with rapidly worsening abdominal distention. Contrast radiographs indicated colon stenosis. Emergent exploratory laparotomy revealed ascending colon stenosis with appendix adhesion; both the lesions were surgically resected. The pathological findings suggested that he had appendicitis several weeks prior to the surgery; the onset of colon lesion seemed later than that of appendix. The perforated appendix was covered by the ascending colon, and inflammatory reactions led to the narrowing of the intestinal lumen.ConclusionsNeonatal appendicitis and colon stenosis are both challenging for the diagnosis, and early laparotomy is necessary when these conditions are suspected.

Appendicitis in a baby born to a woman with preeclampsia

Abstract Neonatal appendicitis is a rare and difficult to diagnose condition but with a high mortality. Co-morbidities as necrotizing enterocolitis or Hirschsprung disease are commonly associated, but other conditions as fetal hypoxia or prematurity are considered also as risk factors. Here is reported a case of neonatal appendicitis in a baby from a woman with preeclampsia, suggesting it might also be another prenatal condition to be taken in consideration during the differential diagnosis.

Neonatal Apandisite Eşlik Eden Psoas Apsesi: Olgu Sunumu

Neonatal Apandisite Eşlik Eden Psoas Apsesi: Olgu Sunumu

Neonatal Perforated Appendicitis

Abstract Introduction Neonatal perforated appendicitis is a rare condition associated with significant morbidity and mortality. The rarity of neonatal appendicitis together with lack of specific signs and low index of suspicion has led to delay in diagnosis and surgical intervention. Here we report an unusual case of neonatal perforated appendicitis mimicking volvulus neonatarum. Methods Patient's case notes were reviewed, presenting history, clinical, diagnostic and intraoperative findings were analyzed. Case report A baby girl, born at 31 weeks of gestation by normal delivery weighing 1.88 kg was referred to surgical team on the 5th day of life for persistent bilious ryles tube aspirate. On examination, abdomen was not distended, no visible peristalsis seen, abdominal wall appeared normal. Abdomen was not tense, no mass was palpable. No other systemic abnormalities were detected. Abdominal x-ray done revealed a gasless abdomen. The provisional diagnosis at that time was midgut volvulus. Based on our provisional diagnosis, patient was scheduled for an emergency laparatomy. Intraoperatively, there was no gush of air, peritoneal fluid was cloudy, no malrotation seen. On gross examination, small bowel appeared to be edematous, there was exudate and pus over the right illiac fossa. On further exploration, the appendix was located at the retrocecal position with perforation at the body and its base was healthy. Large bowel was of normal caliber. Appendicectomy and peritoneal lavage with warm saline was performed. Histopathological examination showed mucosal ulceration associated with transmural neutrophilic infiltration. The mucosal layer is intact. The histopathological diagnosis was acute suppurative appendicitis. Conclusion Neonatal perforated appendicitis continues to be a diagnostic challenge and requires a strong clinical suspicion. This case illustrates an unusual manifestation of neonatal appendicitis in which the clinical and radiological features were those of midgut volvulus. This fortuitously led to emergency laparatomy which revealed the actual diagnosis.

WITHDRAWN: Neonatal perforated appendicitis mimicking volvulus neonatarum: A case report and literature review

WITHDRAWN: Neonatal perforated appendicitis mimicking volvulus neonatarum: A case report and literature review

Perforated appendicitis in a preterm neonate: A case report with literature review

Neonatal appendicitis is a rare entity, with a mortality rate that has decreased in past decades but remained high. Of cases reported in the literature, more than 50% occur in preterm neonates, and none have been diagnosed preoperatively. Here, we report the case of a female infant of 27-4/7 weeks’ gestational age, who presented with perforated appendicitis on day of life (DOL) 30. She was thought to have medically refractory necrotizing enterocolitis (NEC), but was found, instead, to have perforated appendicitis during an exploratory laparotomy. A thorough literature search indicates she is the second youngest neonate to survive perforated appendicitis to date.

Neonatal Perforated Appendicitis Attributed to Localized Necrotizing Enterocolitis of the Appendix: A Review.

Neonatal appendicitis is a rare clinical entity associated with remarkable morbidity and mortality. Appendicular perforation is common and the diagnosis is usually made intra-operatively. The causative etiology of neonatal perforated appendicitis (NPA) is a subject of debate and has not been elucidated. Although many etiologic theories exist, increasing evidence suggests a subset of NPA cases may represent a form of necrotizing enterocolitis (NEC) localized to the appendix. We herein present a review of the current literature to include cases of NPA attributed to localized NEC. A high index of clinical suspicion and early laparotomy are recommended.

Neonatal perforated appendicitis in incarcerated inguinal hernia in the differential diagnosis of testis torsion

Appendicitis in newborns is uncommon and difficult to diagnose. Reports on neonatal appendicitis subsequent to inguinal hernia incarceration are exceptionally rare. We present the case of a 26-day-old infant with perforated appendicitis due to incarceration of a right inguinal hernia, mimicking right testicular torsion.

Idiopathic Perforated Appendicitis in Neonates and Infants

Idiopathic Perforated Appendicitis in Neonates and Infants

Fatal Acute Appendicitis in a Neonate With Congenital Heart Disease.

We describe a case of fatal acute appendicitis in a neonate associated with congenital cardiac disease requiring staged surgery. Neonatal appendicitis is extremely rare and usually associated with prematurity and congenital abdominal conditions. This report serves to highlight the risk of this disease due to vascular insufficiency and ischemia in neonates with congenital cardiac disease and highlight the importance of considering this diagnosis in such a neonate with unexplained sepsis even in the absence of clear abdominal signs.

Neonatal Appendicitis in Term and Preterm Babies

Neonatal Appendicitis in Term and Preterm Babies

Athena's Pages on Neonatal Appendicitis.

Athena has mixed apples and oranges in her article on NA. She has not given definite conclusions, rather left many loose ends at the end, making with unsupported statements. NA is rare. I feel it is probably Systemic Inflammatory Response Syndrome (SIRS) initiated in gut by common enemies of neonate, namely, hypoxia, hypothermia, acidosis and sepsis. This is supported by the fact that occult coagulopathy is seen in many of these cases. I have seen only 3 cases of NA in his 35 years of practice. Even neonatal necrotizing enterocolitis (NEC) is not a pure intestinal disease; it is an intestinal manifestation of endothelial activation, platelet and neutrophil, macrocyte activation initiated by intestinal and systemic factors. I felt that Athena concentrated more on numbers rather than the underlying pathophysiology. All the signs described by Athena for early diagnosis of NA are common to all sources with intra-abdominal pus; I will be happy if Athena responds to this. I strongly feel that budding pediatric surgeons need to know the pathogenesis of neonatal appendicitis. I wish Athena could have added some comments on the currently accepted pathogenesis of neonatal acute appendicitis.

Neonatal Appendicitis (Part 1): A Review of 52 cases with Abdominal Manifestation

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Appendicitis in children less than five years old: A challenge for the general practitioner.

Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness (61% of the patients) followed by guarding (55%), diffuse tenderness (39%), rebound (32%), and mass (6%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis.

Preterm with appendicular abscess and subcapsular liver haematoma

Neonatal appendicitis is a rare yet serious condition. Known reported associations are Hirschsprung’s disease, necrotising enterocolitis (NEC) and cystic fibrosis. The occurrence of subcapsular liver haematoma in preterm neonates can be life threatening. We present an unreported association of these two serious conditions in a preterm infant with appendicular abscess and subcapsular liver haematoma. She presented with sepsis, enlarged liver and tender right iliac fossa mass. Laparotomy was performed for possible complicated NEC. Intraoperatively, there was an appendicular abscess with a small subcapsular liver haematoma and no evidence of NEC. Appendectomy and peritoneal toilet were performed. She had a stormy postoperative period due to sepsis, thrombocytopaenia and expansion of her liver haematoma. The pathology of her appendix was in keeping with appendicitis, with no evidence of NEC. Her liver haematoma gradually resolved. Suction rectal biopsy showed normal ganglia. She was discharged after 7 weeks and remained well since then. Keywords : hematoma, liver, neonatal appendicitis, preterm, subcapsular

Neonatal appendicitis with perforation: A case report

Acute appendicitis is a rare condition in neonates, with a high mortality. We report a preterm baby who presented with clinical picture of necrotizing enterocolitis, and found at laparotomy to have perforated appendicitis.