Neonatal appendicitis: a new look at an old zebra

Jancelewicz, Timothy; Kim, Grace; Miniati, Douglas N.

doi:10.1016/j.jpedsurg.2008.05.014

Cited by 67 publications

(86 citation statements)

References 23 publications

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“…The rarity of neonatal appendicitis has been attributed to various protective features of the neonatal caecal appendage including a funnel-shaped anatomy, infrequency of lymphadenitis-causing infections, as well as soft diet, and recumbent posture [4,5,7]. These characteristics are thought to render REVIEW ARTICLE the neonatal appendix less prone to intraluminal obstruction than their older counterparts [4,5,7].…”

Section: Etiology / Pathophysiologymentioning

confidence: 99%

“…These characteristics are thought to render REVIEW ARTICLE the neonatal appendix less prone to intraluminal obstruction than their older counterparts [4,5,7]. Three etiological theories of neonatal appendicitis exist and are supported by the incidence of associated conditions [4]: impaired immunity such as prematurity (arguing it as a variant of NEC) [7,9,[10][11][12]; vascular insufficiency and hypoxemia (cases associated with cardiorespiratory failure) [9,13]; and finally, intestinal obstruction such as Hirschsprung's disease or strangulated Amyand's hernia [7,14,15]. Interestingly, cases attributed to inguinal hernia have better outcomes due to discrete physical findings and early surgical exploration [2,5,14].…”

Section: Etiology / Pathophysiologymentioning

confidence: 99%

“…The clinical presentation of appendicitis in the newborn is nonspecific and overlaps with that of NEC [3,4,9,11]. The most common findings are abdominal distension, tenderness, feeding intolerance, and fever [2,3,17].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…This condition is fatal in approximately a quarter of cases, which can be attributed to its predilection in preterm infants, diagnostic delay, high rate of appendicular perforation, and associated comorbidities [2][3][4]. The causative etiology remains uncertain, and may not be related to intraluminal obstruction as in older patients [4][5][6][7]. NEC is a commonly encountered gastrointestinal emergency in the neonatal intensive care unit (NICU) with a reported incidence of 1-7.7% admissions [8].…”

Section: Introductionmentioning

confidence: 99%

“…NEC is a commonly encountered gastrointestinal emergency in the neonatal intensive care unit (NICU) with a reported incidence of 1-7.7% admissions [8]. Neonatal perforated appendicitis (NPA) is uncommon and increasingly being recognized as a localized form of NEC involving the appendix [4,7,9,10]. Notably, NEC is the most common preoperative misdiagnosis for NPA confirmed intra-operatively [8].…”

Section: Introductionmentioning

confidence: 99%

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Neonatal Perforated Appendicitis Attributed to Localized Necrotizing Enterocolitis of the Appendix: A Review

et al. 2017

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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.

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Section: Etiology / Pathophysiologymentioning

confidence: 99%

Section: Etiology / Pathophysiologymentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neonatal Perforated Appendicitis Attributed to Localized Necrotizing Enterocolitis of the Appendix: A Review

et al. 2017

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Neonatal appendicitis in northern Iran: A case report

Mehrpisheh

Farhadi

Kiasari

et al. 2022

Clinical Case Reports

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

The,

Derikx

et al. 2023

Health Science Reports

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Background and AimsAlthough appendicitis is rare in young infants, the reported mortality is high. Primary aim of this systematic review was to provide updated insights in the mortality and morbidity (postoperative complications, Clavien‐Dindo grades I–IV) of appendicitis in infants ≤3 months of age. Secondary aims comprised the evaluation of patient characteristics, diagnostic work‐up, treatment strategies, comorbidity, and factors associated with poor outcome.MethodsThis systematic review was reported according to the PRISMA statement with a search performed in Pubmed, Embase and Web of Science (up to September 5th 2022). Original articles (published in English ≥1980) reporting on infants ≤3 months of age with appendicitis were included. Both patients with abdominal appendicitis and herniated appendicitis (such as Amyand's hernia) were considered. Data were provided descriptively.ResultsIn total, 131 articles were included encompassing 242 cases after identification of 4294 records. Overall, 184 (76%) of the 242 patients had abdominal and 58 (24%) had herniated appendicitis. Two‐hundred (83%) of the patients were newborns (≤28 days) and 42 (17%) were infants between 29 days and ≤3 months of age. Either immediate, or after initial conservative treatment, 236 (98%) patients underwent surgical treatment. Some 168 (69%) patients had perforated appendicitis. Mortality was reported in 20 (8%) patients and morbidity in an additional 18 (8%). All fatal cases had abdominal appendicitis and fatal outcome was relatively more often reported in newborns, term patients, patients with relevant comorbidity, nonperforated appendicitis and those presented from home.ConclusionMortality was reported in 20 (8%) infants ≤3 months of age and additional morbidity in 18 (8%). All patients with fatal outcome had abdominal appendicitis. Several patient characteristics were relatively more often reported in infants with poor outcome and adequate monitoring, early recognition and prompt treatment may favour the outcome.

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Neonatal appendicitis: a new look at an old zebra

Cited by 67 publications

References 23 publications

Neonatal Perforated Appendicitis Attributed to Localized Necrotizing Enterocolitis of the Appendix: A Review

Neonatal Perforated Appendicitis Attributed to Localized Necrotizing Enterocolitis of the Appendix: A Review

Neonatal appendicitis in northern Iran: A case report

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

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