Neonatal torsion of the vermiform appendix presenting as generalized peritonitis: a case report of a 10-day-old infant

Introduction: Torsion of the vermiform appendix is an extremely rare surgical emergency in children and has not previously been reported during the neonatal period. Because clinical manifestations are nonspecific, the diagnosis is usually established intraoperatively. We report a case of appendiceal torsion occurring in a 10-day-old male neonate who was diagnosed and treated at our institution. Case presentation: A 10-day-old male neonate was admitted with poor feeding, non-bilious vomiting, and fever. Emergency surgery was indicated based on clinical findings and abdominal radiographic features suggestive of generalized peritonitis secondary to perforated appendicitis. The preoperative diagnosis was peritonitis due to perforated appendicitis, and appendiceal torsion was identified only during surgery. The appendix was hemorrhagic, necrotic, and twisted 360° counterclockwise, with a narrow mesoappendix at its base. Appendectomy was performed, and the patient had an uneventful postoperative recovery. Discussion: This case represents the first reported appendiceal torsion in Vietnam and, to our knowledge, the youngest patient and the first neonatal case described worldwide. A narrow mesoappendix and inflammatory changes of the appendix were considered possible contributing factors. Because the clinical presentation is difficult to distinguish from acute appendicitis, most cases are diagnosed intraoperatively. Conclusion: Appendiceal torsion can occur in neonates. Although rare and unlikely to alter surgical decision-making, it should be considered in the differential diagnosis of a neonatal surgical abdomen.