Acute appendicitis in the first two years of life

Grosfeld, Jay L.; Weinberger, Malvin; Clatworthy, H. William

doi:10.1016/s0022-3468(73)80096-x

Cited by 66 publications

(27 citation statements)

References 9 publications

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“…5,6 Fecaliths causing luminal obstruction and appendicitis are not reported in neonates. 6 Instead, appendiceal inflammation secondary to distal colonic obstruction from Hirschsprung'sdisease 7 blockage from internal or external hernias 8,9 appendicitis and perforation from meconium plugs 2 and from necrotizing enterocolitis 5 have been reported. A survey of the world literature by Buntainet al in 1984 showed 67 cases of appendicitis in the neonatal group; perforation was found in 76% and mortality was as high as 64%.…”

Section: Discussionmentioning

confidence: 99%

“…2,9,10 The occurrence of diarrhea varied from 8% to 30%. 2,11 In a study of 63 children under 3 years who underwent appendectomy for acute appendicitis during 1983-1994, Horwitz et al found that a history of diarrhea at presentation and perforation and/or gangrene at laparotomy were the only independent predictors of prolonged hospitalization. 11 Vomiting, diarrhea and irritability could be attributed to other conditions occurring in this age group such as gastroenteritis, upper respiratory tract infections and otitis media.…”

Section: Discussionmentioning

confidence: 99%

“…24 The high perforation rates in the series of Grosfeld and Barker (94% and 92%, respectively) could be related to the significant delay in diagnosis and appendectomy. 2,23 Conventional open appendectomy has generally been accepted as the immediate treatment for appendicitis. In perforated appendicitis, many institutions have adopted a more vigorous approach, consisting of immediate appendectomy, irrigation of peritoneal cavity, transperitoneal drainage through the wound and a 10-day course of intravenous antibiotics.…”

Section: 9-mentioning

confidence: 99%

“…Radiographic findings believed to be suggestive of appendicitis in older infants and children include localized ileus, soft tissue masses, right lower quadrant abdominal masses, bowel obstruction, scoliosis and appendicoliths. [2][3][4]11 The presence of extraluminal gas indicates perforation. In earlier reports, a calcified fecalith was generally accepted as a definite sign of appendicitis with a 28% to 33% incidence in pediatric appendicitis.…”

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confidence: 99%

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Acute Appendicitis in Infants: Still a Diagnostic Dilemma

Cherian

Egaily²,

Joseph³

2003

Ann Saudi Med

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Acute appendicitis is the most common pediatric surgical emergency, constituting 10% of all children admitted to the pediatric emergency department.1 However, appendicitis, in infants under 2 years of age is uncommon, constituting only 2% of all cases.2,3 Its incidence is much lower in neonates and young infants. Since the diagnosis is uncommon and hence unsuspected in this younger age group, treatment is often delayed and perforation is almost certain. Although the mortality rate has been significantly reduced by improvements in pre-operative fluid resuscitation, anesthetic and surgical techniques, post-operative care and the use of broad-spectrum antibiotics, late recognition has lead to increased post-operative morbidity and prolonged hospitalization. 4 We report a case of acute appendicitis and perforation in a 78-day old infant, who presented with fever, irritability and abdominal distension. Case ReportA 78-day old male infant presented to the emergency room (ER) with a history of fever, refusal of feeds, constipation, irritability and excessive crying for 24 hours. There was no vomiting. The infant was the product of an uneventful full-term pregnancy and cesarian delivery performed because of fetal distress and shoulder dystocia. The mother had premature rupture of membranes 15 days prior to delivery for which she received intravenous antibiotics. His birth weight was 1850 grams. A septic work up was negative and neonatal screening showed G6PD deficiency. When the patient was seen in the ER, his temperature was 39.2°C, heart rate was 160 per minute and respiratory rate was 34 per minute. He was irritable and crying, and hence examination was difficult.The abdomen was distended, but not rigid. Peristalsis was heard. No mass could be palpated and digital examination of the rectum was unremarkable. Urine examination was normal. His white cell count was 7.7 x 10 3 with 46% neutrophils. Blood chemistry as well CSF analysis was normal. Plain abdominal radiograph showed gasfilled small bowel loops in the central abdomen suggestive of ileus. There was no obvious wall or mucosal thickness nor any intraabdominal calcification. The infant was admitted for further management. Ultrasound examination of the abdomen waslimited due to significant abdominal distension and a large amount of bowel gases; however, no fluid collection or masses were found. Barium enema failed to show any gross abnormality of recto-sigmoid or appendix. There was no evidence of intussusception. A laparotomy was performed seven hours after admission. The appendix was found inflamed showing perforations at the tip as well as the base and the area of right lower quadrant was filled with a fibrinous material. The peritoneal cavity contained free purulent fluid. Appendectomy was performed followed by copious saline washing into all the four quadrants and insertion of Penrose drains. Postoperative CT scan of the abdomen ruled out any intra-peritoneal abscesses. Microscopic examination of the appendix revealed marked luminal dilatation with inspissate...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: 9-mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Acute Appendicitis in Infants: Still a Diagnostic Dilemma

Cherian

Egaily²,

Joseph³

2003

Ann Saudi Med

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show abstract

“…10 It is more common in preterm males. 7,11 The diagnosis of acute appendicitis is rarely considered in the differential diagnosis of acute abdomen in the newborn.…”

Section: Discussionmentioning

confidence: 99%