Neonatal appendicitis in a preterm male infant: A case report

Neonatal appendicitis (NA) is a rare condition with a reported incidence of 0.04–0.2 %, and a high mortality rate of approximately 28 %. Preoperative diagnosis of NA remains challenging due to its nonspecific and variable clinical presentation. The patient was a 7-day-old preterm male born at 35 weeks of gestation with a birth weight of 1400g, and Apgar scores of 9,9,10 to a 16-year-old primigravid mother. The pregnancy was uneventful, with no maternal complications and no antenatal imaging. On day 4 of life he developed abdominal distension, with associated blood-stained nasogastric aspirates. On examination, he was tachycardic (198 bpm) and febrile (38.5 °C). The abdomen was distended, tender, and had no bowel sounds on auscultation. Abdominal radiography showed pneumoperitoneum. Laboratory results showed elevated c-reactive protein (65mg/L). An emergency exploratory laparotomy revealed a perforated appendix with right iliac fossa contamination, and grossly normal small bowel, colon and stomach. An appendicectomy was performed and the abdominal cavity irrigated with saline solution. Histopathology confirmed acute appendicitis. Postoperative rectal suction biopsy done day 3 post laparotomy excluded Hirschsprung's disease. The infant's recovery was uneventful. Full feedings were reached by day 5 post laparotomy, and he was discharged home on day 10 post laparotomy. He was seen in follow up at 1 month of age at the outpatient clinic and was growing well. Although rare, perforated appendicitis should be included in the differential diagnosis of neonates who develop an acute abdomen and have a pneumoperitoneum.