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Introduction: Neonatal appendicitis is extremely rare and lacks specific clinical signs. Given its rarity, lack of specific physical signs and the subsequent low index of suspicion; diagnosis and surgical intervention are often delayed in neonates resulting in significant morbidity and mortality. Case presentation: We describe the case of a premature twin male born via spontaneous vaginal delivery at 22 weeks of gestation. Due to hypoxic respiratory failure and sepsis at birth, he required prolonged ventilator support and intermittent vasopressor support. On the 26th day of life, he developed feeding intolerance with hypotension and was found to have abdominal distension and significant pneumoperitoneum on plain radiograph without signs of peritonitis on physical exam. During an emergent laparotomy with ileocecectomy, he was found to have acute gangrenous appendicitis with large perforation at the base. Pathology examination demonstrated transmural necrosis of the appendix with perforation and an abundance of ganglion cells throughout the length of the examined bowel, excluding the possibility of Hirschsprung's disease. Conclusion: While neonatal appendicitis is historically considered rare, given improved survival of premature babies due to medical advances in perinatal care, it is expected that the incidence of neonatal appendicitis will continue to rise. Our case report describes the unusual presentation of neonatal appendicitis without peritonitis despite significant pneumoperitoneum and it highlights the importance of having a thorough understanding of the nonspecific signs of neonatal appendicitis and a higher index of suspicion with a comprehensive differential diagnosis to facilitate a timely diagnosis and initiate urgent surgical intervention.

Appendicitis in infants is a life-threatening condition that is seldom studied. Our purpose was to conduct a comprehensive evaluation of appendicitis in this age group. This was a multicenter retrospective study. Patients aged under one year with surgically confirmed appendicitis during January, 2010 to May, 2022 were identified from four institutional databases. The patients were grouped as neonates or older infants based on their age at the onset of symptoms associated with acute appendicitis. The study encompassed 98 infants, with median age of 66.5 (IQR, 13.8–176.0) days. Neonates were more likely to exhibit abdominal distension (64.9%) and fever (56.8%), while older infants more frequently presented with fever (88.5%) and vomiting (49.2%). Most patients (76.5%) were misdiagnosed during their initial clinical encounter, with a –rate was 3.1% (3 deaths), with neonates exhibiting a rate of 5.4%, and older infants 1.6%. Compared to older infants, neonates showed a higher incidence of appendiceal perforation (OR, 2.9; 95%CI, 1.1–8.1), mechanical ventilation (OR, 9.5; 95%CI, 3.1–29.2), and ICU admission (OR, 16.1; 95%CI, 5.6–45.7). However, there were no significant differences in mortality rates, 30-day readmission rates, and surgical complications between the two groups. Conclusion: Although most infants with appendicitis were misdiagnosed during the first clinical encounter, the observed mortality rates were considerably lower than previously reported. While neonates and infants over 28 days displayed differing clinical presentations and disease severity, their outcomes were similar. What is Known: • Appendicitis in infants is a critical yet underemphasized health concern, often misdiagnosed at initial clinical encounters due to its atypical presentation and non-specific symptoms. • The mortality rates in the neonates with appendicitis was 23% during the past decades. What is New: • The neonates and older infants displayed differing clinical presentations and disease severity. The treatment outcomes were similar. • The mortality rate for infantile appendicitis (3.1%) was significantly lower than historically reported. [ABSTRACT FROM AUTHOR]

Background: Neonatal acute apendicitis in the newborn is an extremely rare surgical entity, its incidence is 0.04% to 0.2%, and it represents a diagnostic challenge in this group of patients. For this reason, it is not usual to suspect this pathology when we are facing an acute neonatal abdomen; mostly there is a delay in diagnosis and management. And although the literature shows a decrease in mortality, it is still around 28% in some reviews.Case report: We report a female neonate with complicated acute appendicitis, who at the beginning did not present evident symptoms and did not respond to medical management. On the sixth day, due to poor evolution, he was admitted to surgery with findings: free meconium in the abdominal cavity with a 1-cm-diameter punch-type perforation in the distal ileum (4 cm from the ileus-caecal valve), which was crushed with phlegmonous cecal appendix; Cecum and omentum with abundant fibrin around.Conclusion: The timely diagnosis of acute appendicitis in neonates continues to represent a challenge for neonatologists. Due to its low frequency but high lethality, it should be considered as a diagnostic option against a baby with an acute abdomen that does not show clinical findings of frequent pathologies in addition to an unusual clinical course.

Acute perforated appendicitis is rare in neonates and is associated with high morbidity and mortality. This is mainly because the rarity of the pathology and the abnormal clinical features cause delays in diagnosis and definitive management. We report a case of a premature neonate who presented with sudden onset of abdominal distension associated with an inability to pass stools. The initial abdominal X-ray showed free air under the right hemi-diaphragm. An emergency laparotomy was performed revealing a perforation at the appendicular tip. An appendectomy was done, and the neonate recovered well with a mild surgical site infection during the course of recovery. Neonatal perforated appendicitis is rare, and clinicians need to consider it as a differential diagnosis due to the atypical presentations. This preterm neonate presented with clinical features of intestinal obstruction and was found at laparotomy to have a perforated appendix at the tip due to neonatal appendicitis.

Background: Acute appendicitis in a newborn is rare and may be fatal. The reported incidence is 0,04 % to 0,2 %. Diagnosis remains challenging as the symptoms are undefined. Case presentation: Here we present a full-term newborn boy of 9 days presenting with malaise, reluctance to feed and subfebrile fever. Over the course of 6 days his condition became worse. The newborn was febrile, passed no stool and his stomach became distended. Perforation due to necrotizing enterocolitis was highly suspected. The diagnosis of acute appendicitis was finalized perioperatively after the perforation and worsening condition made the emergency surgery inevitable. After 16 days of admission the patient was discharged in good condition. Conclusion: Appendicitis in neonates is a dangerous yet manageable condition. While rare it should be included in differential diagnosis when presented with atypical necrotizing enterocolitis or unexplained peritonitis. Quick and accurate diagnosis may increase survival rates.

Neonatal appendicitis is a very rare event leading to acute abdomen manifestation in neonatal period, and is associated with high mortality rates. In these patients, symptoms and findings are not apparent, most of the time, urgent surgery is carried out without preoperative diagnosis; and diagnoses are made with intraoperative or pathological results. In the present case, an neonatal appendicitis case that had psoas abscess with swelling and circulatory disorder in the right leg on the 15th day of life was presented.

Abstract Background Colon 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 presentation Here 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. Conclusions Neonatal appendicitis and colon stenosis are both challenging for the diagnosis, and early laparotomy is necessary when these conditions are suspected.

Necrotizing enterocolitis(NEC) is the most significant gastrointestinal emergency in neonates, particularly affecting those who are premature. Neonatal appendicitis is highly uncommon in term infants and its diagnosis is typically incidental. The clinical presentation of newborn appendicitis is nonspecific and usually mimics that of NEC. Pneumatosis intestinalis is a finding that is extremely specific to NEC; it is very surprising to observe this finding in a patient with acute appendicitis. A 2730-g male infant was born at 39 weeks gestation to a 33-year-old mother. 30 minutes after delivery, the patient exhibited grunting and respiratory distress and was subsequently admitted to the Neonatal Intensive Care Unit. On the 7th day, the patient developed nutrition intolerance. The feeding was discontinued and the nasogastric catheter was switched to free drainage. Abdominal examination and laboratory parameters were not significant, but direct abdominal radiographs showed findings suggesting pneumatosis intestinalis. NEC was considered and the antibiotics were revised accordingly. The department of pediatric surgery was consulted as the patient's abdominal examination and radiographs showed abnormalities suggestive of advanced NEC. The patient was taken into operation, gangrenous appendicitis was detected and an appendectomy was performed. When considering the differential diagnosis of NEC in neonatal patients, especially in term infants, clinicians should be mindful of acute appendicitis. In this study, we present a case of neonatal appendicitis, which is relatively common in pediatric cases but uncommon in the neonatal period, presenting as atypical NEC. [ABSTRACT FROM AUTHOR]

Cystic neuroblastoma, characterized by large cystic lesions typically originating from the adrenal gland, is a rare entity often diagnosed in the perinatal period. The majority of cases are localized, and complete surgical resection is curative in these cases. We present the case of a 3-week-old male infant who on imaging was found to have a cystic right suprarenal mass that was concerning for cystic neuroblastoma. At exploration, it was determined that this mass was a right upper quadrant abscess secondary to perforated appendicitis. Two years after his operation, the patient is doing well with no long-term complications.

Neonatal appendicitis is a very rare entity associated with immune, vascular, hypoxic, and obstructive factors. We present two cases of neonatal appendicitis with different characteristics. The first case is a 15-day-old newborn with congenital hypothyroidism who had abdominal distension and sepsis data. An appendicular plastron was found. Hirschsprung's disease was ruled out through biopsies. The second case is a 27-week-old preterm newborn with history of necrotizing enterocolitis who presented an incarcerated inguinal hernia consistent with Amyand's hernia. The prognosis of neonatal appendicitis varies according to how fast diagnosis is achieved, since it is associated with high mortality rates in the first hours. Although appendicitis is the condition best known to the pediatric surgeon, it represents a diagnostic challenge in newborns as a result of its extreme rarity and how likely it is to present comorbidities. [ABSTRACT FROM AUTHOR]

Acute appendicitis is an infrequent condition in neonates, especially in term infants. With around 100 cases in the last century and no specific diagnostic tool, this case report is an addition to the existing literature that helps in our understanding of the disease. A preterm infant who had greenish aspirates and dilated bowel loops on abdominal x ray and was treated on the lines of necrotizing enterocolitis failed to improve. Baby had issues of abdominal distension whenever feeds were started hence exploratory laparotomy was done on the 45th day of life which showed appendicitis with adherent terminal ileum, caecum, and appendix. Two months after the surgery, the patient was unable to respond to antibiotic therapy for septic condition leading to death. [ABSTRACT FROM AUTHOR]

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.

Background: Colon 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 Presentation: Here 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.Conclusions: Neonatal appendicitis and colon stenosis are both challenging for the diagnosis, and early laparotomy is necessary when these conditions are suspected. [ABSTRACT FROM AUTHOR]

Neonatal appendicitis is extremely rare and lacks specific clinical signs. Given its rarity, lack of specific physical signs and the subsequent low index of suspicion; diagnosis and surgical intervention are often delayed in neonates resulting in significant morbidity and mortality. We describe the case of a premature twin male born via spontaneous vaginal delivery at 22 weeks of gestation. Due to hypoxic respiratory failure and sepsis at birth, he required prolonged ventilator support and intermittent vasopressor support. On the 26th day of life, he developed feeding intolerance with hypotension and was found to have abdominal distension and significant pneumoperitoneum on plain radiograph without signs of peritonitis on physical exam. During an emergent laparotomy with ileocecectomy, he was found to have acute gangrenous appendicitis with large perforation at the base. Pathology examination demonstrated transmural necrosis of the appendix with perforation and an abundance of ganglion cells throughout the length of the examined bowel, excluding the possibility of Hirschsprung's disease. While neonatal appendicitis is historically considered rare, given improved survival of premature babies due to medical advances in perinatal care, it is expected that the incidence of neonatal appendicitis will continue to rise. Our case report describes the unusual presentation of neonatal appendicitis without peritonitis despite significant pneumoperitoneum and it highlights the importance of having a thorough understanding of the nonspecific signs of neonatal appendicitis and a higher index of suspicion with a comprehensive differential diagnosis to facilitate a timely diagnosis and initiate urgent surgical intervention. [ABSTRACT FROM AUTHOR]

Abstract Background Acute appendicitis in a neonate and premature baby is still considered a rare entity as diagnosis is always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis. Our reported case is a premature baby who had a perforated appendix with no evidence of peritonitis. Case presentation We describe the case of a premature Bahraini girl born at 29 weeks of gestation by spontaneous vaginal delivery to a 39-year-old G6P5 mother. She was kept on a ventilator for the first 6 days of life, and had an uneventful Neonatal Intensive care stay until her 47th day of life when she developed sepsis that required ventilator support for 3 days. At day 51 she developed abdominal distension and was referred to a pediatric surgeon by day 54 with pneumoperitoneum. Her abdomen was soft with minimal tenderness and no evidence of erythema or edema. In view of pneumoperitoneum and previously reported sepsis, she was taken for exploratory laparotomy. The findings were consistent with a perforated appendix with no evidence of peritonitis or necrotizing enterocolitis. An appendectomy was performed. She had a smooth postoperative recovery. Conclusions Neonatal appendicitis continues to be a diagnostic challenge. Only with a high index of clinical suspicion and teamwork can these cases be managed successfully and mortality and morbidity rates may reduce.

Neonatal appendicitis is a very rare event leading to acute abdomen manifestation in neonatal period, and is associated with high mortality rates. In these patients, symptoms and findings are not apparent, most of the time, urgent surgery is carried out without preoperative diagnosis; and diagnoses are made with intraoperative findings or pathological results. In the present case, a case with neonatal appendicitis that had psoas abscess with swelling and circulatory disorder in the right leg on the 15th day of life is presented. [ABSTRACT FROM AUTHOR]

Neonatal appendicitis carries a high mortality rate. We describe a peculiar case presented after an incarcerated hernia manually reduced in a 4-week-old male neonate with ipsilateral undescended testis. Laparoscopy allowed a prompt recognition of an unexpected intra-abdominal life-threatening condition. Pathogenesis, treatment, and outcome are discussed on the light of a comprehensive literature review.

Neonatal appendicitis is a rare clinical entity associated with remarkable morbidity and mortality. Appen¬dicular 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 litera¬ture to include cases of NPA attributed to localized NEC. A high index of clinical suspicion and early laparotomy are recommended.

A preterm neonate underwent emergent laparotomy for presumed necrotizing enterocolitis (NEC). Intra-operatively, neonatal perforated appendicitis (NPA) was encountered. This may represent a form of NEC localized to the appendix. A high index of clinical suspicion and early laparotomy are recommended.

Background: Acute appendicitis in a neonate and premature baby is still considered a rare entity as diagnosis is always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis. Our reported case is a premature baby who had a perforated appendix with no evidence of peritonitis.Case Presentation: We describe the case of a premature Bahraini girl born at 29 weeks of gestation by spontaneous vaginal delivery to a 39-year-old G6P5 mother. She was kept on a ventilator for the first 6 days of life, and had an uneventful Neonatal Intensive care stay until her 47th day of life when she developed sepsis that required ventilator support for 3 days. At day 51 she developed abdominal distension and was referred to a pediatric surgeon by day 54 with pneumoperitoneum. Her abdomen was soft with minimal tenderness and no evidence of erythema or edema. In view of pneumoperitoneum and previously reported sepsis, she was taken for exploratory laparotomy. The findings were consistent with a perforated appendix with no evidence of peritonitis or necrotizing enterocolitis. An appendectomy was performed. She had a smooth postoperative recovery.Conclusions: Neonatal appendicitis continues to be a diagnostic challenge. Only with a high index of clinical suspicion and teamwork can these cases be managed successfully and mortality and morbidity rates may reduce. [ABSTRACT FROM AUTHOR]

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Acute neonatal appendicitis is very rare in the neonatal period. It is usually associated with comorbidity including prematurity. Symptoms are non-specific. The prognosis is marked by high risk of mortality and morbidity. Here, we report a case of preterm new born who presented with sepsis, apnoea, and digestive signs. The laparotomy revealed perforated appendicitis complicated with peritonitis.

Neonatal appendicitis carries a high mortality rate. We describe a peculiar case presented after an incarcerated hernia manually reduced in a 4-week-old male neonate with ipsilateral undescended testis. Laparoscopy allowed a prompt recognition of an unexpected intra-abdominal life-threatening condition. Pathogenesis, treatment, and outcome are discussed on the light of a comprehensive literature review. [ABSTRACT FROM AUTHOR]

Appendicitis in the neonatal period is extremely rare. Its low incidence together with non-specific clinical symptoms often mean the diagnosis is delayed, leading to increased rates of peritonitis and mortality. We report the case of a 33-week premature infant, small for gestational age (1180 g at birth), clinically stable and receiving exclusive enteral feeding, who presented clinical manifestations of necrotizing enterocolitis at 14 days of life. Acute phase reactants were elevated and abdominal radiography showed pneumoperitoneum. Laparotomy revealed acute perforated appendicitis without intestinal involvement and purulent fluid in the peritoneum, for which appendectomy was performed. Neonatal acute appendicitis should be considered in the differential diagnosis of abdominal sepsis since early diagnosis and treatment significantly reduce associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

Appendicitis in infants under 2 years of age is uncommon: only 2% of all cases. Its incidence is much lower in neonates, about 0.2% of all cases. Since the diagnosis is uncommon and hence unsuspected in this age group, treatment is often delayed, for which reason perforation and peritonitis is almost always present. In the differential diagnosis the etiology of this condition should include appendiceal inflammation secondary to distal colonic obstruction from Hirschsprung's disease blockage, from internal or external hernias, appendicitis and perforation from meconium plugs, choriamnioitis, streptococal sepsis, cystic fibrosis and from necrotizing enterocolitis. The present case is an 8 days old febrile female who presented at the second day of life. The patient refused feeding; she had abdominal distention with shiny skin, very irritable. There were bloody stools. Abdomen was tender to palpations; bowel sounds were absent. A laparotomy was performed .There was free meconial fluid in the peritoneal cavity; the appendix was perforated; a 2 mm perforation was also present in the transverse colon. The perforation was closed and Oschner appendectomy was done followed by peritoneal lavage. Biopsies from the colon and the sigmoid were taken. The patient improved and began to tolerate formula. Stools became normal. She had been given cefotaxime, metronidazole and amikacin. The symptomatology of this condition is not revealing. The possibility of appendicitis should be suspected in an infant with an acute abdomen. Diagnosis requires a high index of suspicion. Early appendectomy before perforation occurs is the ideal treatment, but establishing a diagnosis in neonates is exceptional. [ABSTRACT FROM AUTHOR]

Cystic neuroblastoma, characterized by large cystic lesions typically originating from the adrenal gland, is a rare entity often diagnosed in the perinatal period. The majority of cases are localized, and complete surgical resection is curative in these cases. We present the case of a 3-week-old male infant who on imaging was found to have a cystic right suprarenal mass that was concerning for cystic neuroblastoma. At exploration, it was determined that this mass was a right upper quadrant abscess secondary to perforated appendicitis. Two years after his operation, the patient is doing well with no long-term complications. [ABSTRACT FROM AUTHOR]

We report a novel case of ruptured appendicitis in a premature neonate which radiographically mimicked necrotizing enterocolitis with free intraperitoneal air. On exploratory laparotomy, both the large and small intestines were normal. [ABSTRACT FROM AUTHOR]