Acute Abdomen in an Extremely Low-Birth-Weight Preterm Neonate: A Case of Appendicitis

Abstract

Introduction Neonatal appendicitis is a very rare surgical entity. Non-specific symptoms such as feeding intolerance, abdominal distension, vomiting, increased gastric residue, lethargy, and fever may be present. The majority of reported cases could not be identified early. In this report, we present an extremely low-birth-weight preterm neonate who has been diagnosed with appendicitis.

Case Presentation A 980-gram preterm baby girl was born at 31 1/7 weeks of gestation. The physical examination was normal at birth. Her initial clinical course was uneventful. On the 7^th day of life, she developed abdominal distention and tenderness. She had an episode of bloody stools and bilious vomiting. An abdominal X-ray suggested localized perforation in the cecum with an air-fluid level in the right lower quadrant. The clinical findings suggested necrotizing enterocolitis and perforation, and a diagnostic laparotomy was performed. The bowel was found to be normal with a necrotic appendix. The appendectomy was performed. She was discharged from the neonatal intensive care unit with no complications.

Conclusion Appendicitis is extremely rare in the neonatal period. It is quite challenging to evaluate the presentation accurately, which causes a delay in diagnosis. However, if an atypical NEC or peritonitis is present, appendicitis should be considered. Early diagnosis and timely surgical intervention improve the prognosis of neonatal appendicitis.

Key words

acute abdomen - extremely low-birth-weight preterm - neonatal appendicitis - necrotizing enterocolitis - peritonitis

• References

• 1 Khan RA, Menon P, Rao KL. Beware of neonatal appendicitis. J Indian Assoc Pediatr Surg 2010; 15: 67-69
• 2 Karaman A, Cavusoglu YH, Karaman I. et al. Seven cases of neonatal appendicitis with a review of the English language literature of the last century. Pediatr Surg Int 2003; 19: 707-709
• 3 Raveenthiran V. Neonatal appendicitis (part 1): A review of 52 cases with abdominal manifestation. J Neonatal Surg 2015; 4: 4
• 4 Tumen A, Chotai PN, Williams JM. et al. Neonatal perforated appendicitis attributed to localized necrotizing enterocolitis of the appendix: A review. J Neonatal Surg 2017; 6: 60
• 5 de la Hunt MN. The acute abdomen in the newborn. Semin Fetal Neonatal Med 2006; 11: 191-197
• 6 Arroyo IC, de Alarcón García JR, Ramos JP. et al. Neonatal appendicitis: how many sides does this coin have?. Cir Pediatr 2021; 34: 143-146
• 7 Jancelewicz T, Kim G, Miniati D. Neonatal appendicitis: a new look at an old zebra. J Pediatr Surg 2008; 43: e1-e5
• 8 Stiefel D, Stallmach T, Sacher P. Acute appendicitis in neonates: complication or morbus sui generis?. Pediatr Surg Int 1998; 14: 122-123
• 9 Mallikarjuna Swamy P, Pejaver RK, Babu A. et al. Appendicular perforation in necrotising enterocolitis. Indian Pediatrics 1998; 35
• 10 Raveenthiran V. Neonatal appendicitis (part 2): A review of 24 cases with inguinoscrotal manifestation. J Neonatal Surg 2015; 4: 15
• 11 Arliss J, Holgersen LO. Neonatal appendiceal perforation and Hirschsprung's disease. J Pediatr Surg 1990; 25: 694-695
• 12 Bence CM, Densmore JC. Neonatal and infant appendicitis. Clin Perinatol 2020; 47: 183-196
• 13 Schwartz KL, Gilad E, Sigalet D. et al. Neonatal acute appendicitis: a proposed algorithm for timely diagnosis. J Pediatr Surg 2011; 46: 2060-2064
• 14 Si SY, Guo YY, Mu JF. et al. The sonographic features of neonatal appendicitis: A case report. Medicine (Baltimore) 2017; 96: e8170