Perforated appendicitis in a preterm neonate: A case report with literature review

Bose, Sanuja; Wakeman, Derek

doi:10.5430/css.v3n4p6

Cited by 2 publications

(4 citation statements)

References 15 publications

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“…Mortality in the newly published 31-case series of Huang et al was 0% [5]. Considering the new case reports and the two patients we reported, we think that mortality is much lower today [2,[4][5][6][7][8][9][10]. However, we cannot explain this decline in mortality by early diagnosis because preoperative diagnosis of acute appendicitis is very low and perforation rates are still high.…”

Section: Discussionmentioning

confidence: 87%

“…There are three important etiologic causes that are discussed classically. First, it is considered to be an isolated form of NEC because it is more common in preterms [6][7][8]. However, we know from recent publications that neonatal appendicitis is more common in term babies than in preterms and the appearance of the intestines during surgery is generally normal [1,5].…”

Section: Discussionmentioning

confidence: 99%

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Neonatal and infantile appendicitis still confuses minds: report of two cases

Okumuş

Zübarioğlu

2020

Ann Pediatr Surg

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Background: Acute appendicitis is extremely rare in the neonatal and infantile periods. The number of cases published in the last century is just over 100. Mortality and morbidity are still high due to diagnostic problems because there are no specific clinical features and reliable investigation for the diagnosis. Herein, we present two patients to remind physicians that the diagnosis of neonatal and infantile appendicitis should always be kept in mind. Case presentations: A 30 3/7-week-old 740-g newborn girl was delivered by cesarean section because of preeclampsia. The newborn was followed in the neonatal intensive care unit and fed with an orogastric catheter. An abdominal distention developed on the 18th day of her life. While following up with a preliminary diagnosis of necrotizing enterocolitis, she was operated on the 4th day due to abdominal free air seen on X-ray. A perforated appendicitis was detected in the abdominal exploration and formal appendectomy was performed. Histology demonstrated marked transmural inflammation and necrosis at the perforated site and there was no evidence of Hirchsprung's disease. The patient was started on breast milk on the third postoperative day and discharged home on day 98. A 3.5-month-old boy was admitted to our clinic because of abdominal distention, discomfort, and constipation which had been ongoing for 4 days. He was followed up as an outpatient basis for 4 days in another center with the diagnosis of infantile colic. An increase in echogenicity due to intense inflammation was observed in mesenteric plans using USG in the right lower quadrant of the abdomen. Following preoperative preparations, the patient underwent abdominal exploration and appendectomy. He had an uneventful recovery and pathologic examination demonstrated a necrotizing appendicitis with perforation. He was discharged on the fourth postoperative day without any problems. Conclusion: It is a fact that acute appendicitis in neonates and infants may not be diagnosed easily and quickly as in older children because there are no specific clinical features and reliable investigation for the diagnosis. Delay in diagnosis and treatment often results in appendicular perforation and peritonitis. The main safeguard against mortality and morbidity remains a high index of suspicion.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Neonatal and infantile appendicitis still confuses minds: report of two cases

Okumuş

Zübarioğlu

2020

Ann Pediatr Surg

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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 ...…”

Section: Resultsmentioning

confidence: 99%

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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Perforated appendicitis in a preterm neonate: A case report with literature review

Cited by 2 publications

References 15 publications

Neonatal and infantile appendicitis still confuses minds: report of two cases

Neonatal and infantile appendicitis still confuses minds: report of two cases

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

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