Beware of neonatal appendicitis

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

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 7th 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.

Analysis of Cases of Neonatal Appendicitis from a Tertiary Care Unit

OBJECTIVE

To compare the clinical characteristics and prognosis of neonatal appendicitis (NA) alone and neonatal appendicitis with neonatal necrotizing enterocolitis (NEC) to improve the early recognition and diagnosis rate for this type of disease.

METHODS

Cases of appendicitis proved by operation and pathology younger than 28 d old in the authors hospital from 1990 to 2021 were retrospectively analyzed. According to whether combine with NEC, the cases were divided into two groups, analyzes the clinical characteristics.

RESULTS

A total of 48 patients were enrolled, 15 cases in the NA group and 33 cases in the NEC with NA group. The age of onset, time from onset of symptoms to surgical intervention were both earlier in the NEC with NA group (p < 0.05). The preoperative white blood cells (WBC) and platelets (PLT) in the NA group were higher (p < 0.05). NEC with NA was more likely to be complicated with neonatal pneumonia and sepsis before surgery (p < 0.05). The main clinical symptom of NA was abdominal distension, while the other was bloody stool. The positive rate of ultrasound was high before the operation. The perforation rate of the appendix was very high (NA 100% vs. NEC 57.6%). In the NA group, 100% underwent appendectomy and 78.8% in the NEC with NA group underwent terminal ileostomy and appendectomy.

CONCLUSION

The incidence of neonatal appendicitis is low. It is easily misdiagnosed as NEC. The perforation rate is very high, it is recommended to operate as soon as possible, and the prognosis is good.

Neonatal appendicitis in northern Iran: A case report

We presented a case of neonatal appendicitis in a 22‐day‐old premature infant. The patient developed abdominal distension and perforation was suspected. The patient was transferred to the operating room with a diagnosis of peritonitis. Normal bowel loops were seen during surgery. Gangrenous appendicitis was seen. An appendectomy was performed.

Effect of COVID-19 on pediatric appendicitis presentations and complications

PURPOSE

Appendicitis is the most common surgical emergency in children. This study aims to examine how the COVID-19 pandemic affected pediatric patients with acute appendicitis with regards to presentation and complications.

METHODS

After obtaining ethics approval, we performed a chart review of pediatric patients admitted with a diagnosis of appendicitis from March 1, 2019 to June 30, 2019 and March 1, 2020 to June 30, 2020. Data collection included a post-operative period of 30 days. The primary outcome of interest was complication rates post-appendectomy. Secondary outcomes included time to presentation, symptoms, time to surgery, and rate of perforation.

RESULTS

Overall, 205 patients were included with 115 in the pre-pandemic group and 90 in the pandemic group. There was no significant difference in complication rates (16% pre-pandemic vs. 13.3% pandemic). In the pandemic group, time from symptom onset to presentation was significantly longer (1.87 days vs. 2.42 days, p = 0.01), more patients presented with emesis (70% vs. 55%, p<0.05), more patients had perforated appendicitis (47% vs. 32%, p<0.05), more patients were likely to be tachycardic (46% vs. 32%, p = 0.05)  and waited less time for surgery (5.75 h vs. 4.15 h, p = 0.05) which both approached significance.

CONCLUSION

Significant delays in pediatric appendicitis presentation, and higher rates of tachycardia and perforation were seen during the pandemic. This did not result in increased complication rates but could suggest pandemic patients were more ill than their pre-pandemic counterparts.

A Rare Case of Chronic Suppurative Appendicitis in Neonatal Presenting as Intestinal Malrotation

Neonatal appendicitis (NA) is an extremely rare acute abdomen condition, moreover, if it is a chronic suppurative one. The definite risk factor of NA is barely unknown. The signs and symptoms are often nonspecific and appear after perforation occurs. Most of the cases were found unexpectedly during surgery suspected as other diagnoses. A 7-day-old male neonate presenting lethargic and hypoglycemia since 1 st day of life. Patient drunk breast milk right after since he was born. Meconium was produced <24 h. On the 3 rd day of hospitalization, he experienced bilious vomiting and abdominal distension, so nasogastric tube was installed. Physical examination revealed decreased bowel sound. Investigation showed leucocytosis, slightly increased procalcitonin and abdominal X-ray showed that gas distribution lasted until third part of duodenum followed by minimal gas distribution in the distal part of duodenum. The patient was suspected as distal duodenum stenosis or proximal jejunum. Intraoperatively, it was found that there was second part duodenum malrotation and open Ladd’s procedure was done. During Ladd’s procedure, a perforated appendix was also found. The histopathology result revealed that it was a chronic suppurative appendicitis. Patient was discharged in good condition 20 days after surgery. NA is a rare condition with nonspecific signs and symptoms which was usually found accidentally during surgery suspected as other diagnoses.

Analysis of Top ten-Cited Articles Published in the Journal of Indian Association of Pediatric Surgeons Over a 10-Year Period

Aim:

The objective was to identify, analyze, and categorize the characteristics (the type of article, country of origin, institution, authorship, topic, and the number of citations) of the articles published in the Journal of Indian Association of Pediatric Surgeons (JIAPS) from 2008 to 2017, with particular focus on the top ten-cited articles.

Materials and Methods:

The above characteristics of the individual articles were tabulated in the Microsoft Excel^® sheet. The number of citations of an article was obtained from three databases (CrosssRef, MEDLINE, and Google Scholar). A final tally was obtained after removing common entries in the databases.

Results:

The total number of articles published was 613. There were 255 case reports, 209 original articles and review articles, and 149 brief communications. The top five countries of origin of the articles were India, United Kingdom (UK), Turkey, Iran, and Saudi Arabia, with 526, 14, 9, 7, and 6 articles, respectively. The institution, authorship, and topics of the top ten-cited articles were noted.

Conclusion:

Case reports are the most common type of articles published in JIAPS. Most of the articles originated from India, followed by the UK and middle-east countries. This analysis may provide insights to the editorial board and the members of IAPS about the trend of research and publications among the pediatric surgeons of India.

Neonatal and Infant Appendicitis

Neonatal appendicitis is a rare disease with a high mortality rate. Appendicitis is difficult to diagnose in neonatal and infant populations because it mimics other more common conditions in these age groups. Furthermore, signs and symptoms of appendicitis are often nonspecific in nonverbal patients and a high index of suspicion is necessary to initiate the appropriate diagnostic work-up. The keys to successful management of appendicitis in infants include keeping the diagnosis on the differential in the setting of unexplained intra-abdominal sepsis, following a diagnostic algorithm in the work-up of infant abdominal pathology, and performing appendectomy once the diagnosis is confirmed.

Sepsis after non-perforated acute appendicitis

Appendicitis is a worm-like appendage whose base is located on the posterior side of the inner cecum. Acute appendicitis is uncommon in children younger than 5 years old. The patient was a 1.5-year-old boy who was admitted to the hospital with a primary complaint of fever, diarrhea, and vomiting. A pathological report of acute puffiness appendicitis with peri appendicitis was confirmed. After two weeks of treatment, the patient was discharged with an good general condition.

Sonographic Findings of Midgut Malrotation With Volvulus: A Case of Upper Intestinal Obstruction in a Neonate

Midgut malrotation is a congenital condition resulting from incomplete normal intestinal rotation after physiologic gut herniation. While it can remain asymptomatic over an entire lifetime, midgut volvulus is most likely to occur during early life. While an upper gastrointestinal series is the imaging modality of choice for definitive diagnosis, sonography is a safe and effective modality capable of indicating midgut malrotation, especially in pediatric patients. This case study illustrates the sonographic findings associated with intestinal malrotation with volvulus and discusses the etiology, signs, symptoms, and treatment of the condition. In addition, the sonographic findings are correlated with upper gastrointestinal results, which confirmed midgut malrotation. The diagnosis of volvulus secondary to midgut malrotation was confirmed by a laparoscopic Ladd procedure performed to treat the neonate.

Neonatal appendicitis: a survival case study

ABSTRACT Objective: To report a case of neonatal appendicitis in a children’s hospital in southern Brazil, demonstrating the impact on neonatal survival. Method: Case study with data collection from medical records, approved by the Institution and Ethics Committee for Research with Human Beings. Results: The clinical picture is initially characterized by food intolerance, evolving to hypoactivity, alteration of vital signs and septicemia due to intestinal perforation. Management is exclusively surgical, since no case described in the literature was diagnosed preoperatively and the findings usually point to acute abdomen. Conclusion: A focused clinical surveillance should be established when the infant presents peritoneal irritation. Follow-up of the evolution and the worsening of the symptoms by nurses, as part of the care team in partnership with the medical team, enables an early surgical intervention, thereby avoiding complications such as septicemia and death.

A 3-Month-Old With Failure to Thrive and Persistent Vomiting

A 3-month-old boy was admitted from his pediatrician's office for failure to thrive and vomiting. On admission, he weighed barely more than his birth weight and was cachectic with muscle wasting. His abdomen was grossly distended but soft and nontender. A trial of nasogastric feeds resulted in a worsening of his clinical status. He was transferred to the ICU, and diagnostic imaging was concerning for a distal bowel obstruction. Surgical pathology revealed a surprising diagnosis, which is described in detail in the following case.

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.

Acute appendicitis in young children less than 5 years: review article

Despite wide spread availability of sophisticated diagnostic imaging, acute appendicitis in pre-school children remains a diagnostic challenge. Most of these children present late, often with complications e.g. appendicular perforation, abscess formation and peritonitis and as result hospital stay is prolonged and is associated with increased morbidity and mortality.The purpose of this article is to review peculiar features of acute appendicitis in preschool children.

A Rare Case of Neonatal Complicated Appendicitis in a Child with Patau's Syndrome

Neonatal appendicitis is a rare condition with high mortality rate. Signs and symptoms are often nonspecific, imaging modalities are not always diagnostic, and preoperative diagnosis is difficult with subsequent delay and complications. Its pathophysiology may be different from appendicitis in older children and comorbidities can be found. We report a case of a female neonate with Patau's syndrome, intestinal malrotation, and Fallot tetralogy in whom perforated appendix, probably occurring during fetal period due to vascular insufficiency, was found at laparotomy.

Acute neonatal appendicitis: the potential value of laparoscopy as a diagnostic and therapeutic tool

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention in children, but it is very rare in infants and neonates. Nonspecific clinical features and low index of suspicion make its diagnosis and management particularly challenging, which may result in high chances of complications such as perforation and peritonitis, thus increasing morbidity and mortality. We present the case of a female late preterm newborn with bloody stools and bilious gastric aspirates on the second day of life. After 24 h of clinical, laboratory and radiological surveillance, which evidenced deterioration in the newborn’s condition, an exploratory laparoscopy was performed, showing generalized peritonitis and perforated inflammatory appendix. A laparoscopic appendicectomy was performed. Histology confirmed the appendicitis diagnosis. The authors enhance the value of diagnostic laparoscopy and its potential as a therapeutic tool in neonates.

Perforated acute appendicitis in a pre-term neonate

Acute appendicitis is a common occurrence in childhood, but this diagnosis is considered rarely in differential diagnosis of acute abdomen in the neonatal period because its occurrence is very rare in neonates. We report a 20-day- old afghan female baby that was admitted to neonatal intensive care unit, because of irritability and abdominal distension. Complete ultrasound of abdomen and pelvis was normal. In plain Radiographs of chest and abdomen with the exception of Air-filled stomach and intestine, there was no abnormality. Due to the lack of improvement and severe abdominal distension, she was transmitted to the operating room and Surgical exploration revealed perforated appendix. Appendicitis should be considered in the differential diagnosis for a neonate with abdominal distension and bilious vomiting and needs strong clinical suspicion.

Perforated neonatal appendicitis with pneumoperitoneum

Acute appendicitis is a rare condition in neonates, with a high mortality. If perforated, it seldom presents with radiologically significant pneumoperitoneum. An 11-day-old newborn presented with abdominal distension and reluctance to feeds. X-ray abdomen revealed significant pneumoperitoneum. After optimization of his condition, exploratory laparotomy was performed. Perforated appendix was found and appendicectomy done. Post operative course was stormy that lead to demise of the baby.

Perforated appendicitis in a neonate presenting with intestinal obstruction

We report a case of neonatal perforated appendicitis presenting with an early picture of intestinal obstruction secondary to entrapment of small bowel under inflamed appendix vermiformis.

Neonatal appendicitis mimicking intestinal duplication: a case report

Introduction

Acute appendicitis is a common disease in older children but rare in neonates.

Case presentation

We report the case of a 2-day-old Asian baby who suffered from neonatal appendicitis mimicking intestinal duplication. Laparoscopic appendectomy was successfully performed after the trans-umbilical division of adhesions, and the postoperative course was uneventful.

Conclusion

There are few reports describing abdominal masses caused by appendicitis mimicking intestinal duplication. The laparoscopic approach for neonatal appendicitis is considered to be a safe and useful therapeutic modality with good cosmetic results.

Laparoscopic surgery for acute neonatal appendicitis

We present the first two cases of acute neonatal appendicitis operated on through the laparoscopic approach. Acute neonatal appendicitis is uncommon and rarely considered by clinicians when assessing the neonatal acute abdomen. Our two cases demonstrate the potential value of diagnostic laparoscopy in the acute neonatal abdomen that poses a diagnostic dilemma. Furthermore, technical modifications of well-established laparoscopic techniques in the older child enable its use in neonates as a therapeutic tool.