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

Abstract

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.

Appendicitis and its associated mortality and morbidity in infants up to 3 months of age: A systematic review

“…With cross‐referencing, eight additional eligible articles were identified. In total, 131 articles were included in this systematic review 3,6,12–140 . Figure 1 provides the PRISMA flowchart.…”

“…Reported indications were: N = 2 ileocaecal resection due to perforation of the caecum or fistula of the appendix into caecum, N = 1 resection of a part of ascending colon due to local lesion caused by adherent appendix, N = 1 resection terminal ileum due to adherent appendix and cystic lesion, N = 1 Meckel's diverticulum, N = 1 adherent ileal loop, N = 1 old perforation terminal ileum 44,45,69,98,124,131,135 . In one patient a diverticulectomy of a Meckel's diverticulum was performed and in three patients a Ladd's procedure 20,24,104,134 …”

“…In total, 131 articles were included in this systematic review. 3 , 6 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ...…”

“… 44 , 45 , 69 , 98 , 124 , 131 , 135 In one patient a diverticulectomy of a Meckel's diverticulum was performed and in three patients a Ladd's procedure. 20 , 24 , 104 , 134 …”