Seven cases of neonatal appendicitis with a review of the English language literature of the last century

Abstract

Neonatal appendicitis (NA) is a very rare surgical condition. The aim of this study is to once again draw attention to this subject by collecting our cases with NA and cases of NA reported separately in English-language literature over the period from 1901 to 2000. We performed a retrospective chart review of patients admitted to our hospital, with the clinical diagnosis of NA from 1990 to 2000. A survey of the English-language literature together with our own 7 cases revealed a total of 141 cases of NA during the period of 1901-2000. 128 cases had sufficient information for analysis. The patients are grouped and discussed according to these 3 time- periods: 1901-1975, 1976-1984 and 1985-2000. The incidence, etiology, and presenting signs and symptoms of appendicitis in newborns are discussed. Despite the similar perforation rates in the 3 time- periods (73%, 70%, 82%), mortality rate in NA has decreased from 78% in the 1901-1975 period, to 33% in the 1976-1984 period, and to 28% in the 1985-2000 period. A newborn baby presenting with continuous vomiting, refusal to feed, and, showing signs of pain through irritability, restlessness, sleep disturbance, and a distended abdomen; one should strongly suspect an abdominal disorder, perhaps appendicitis.

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

“…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].…”

“…The most common findings are abdominal distension, tenderness, feeding intolerance, and fever [2,3,17]. Approximately 50% of cases occur in premature neonates and a third of cases are initially diagnosed as NEC [3].…”

“…Approximately 50% of cases occur in premature neonates and a third of cases are initially diagnosed as NEC [3]. Historically, the mortality rate was nearly 80% and the diagnosis was often made on autopsy [2,7]. The reported mortality rate of NPA in recent years ranges from 18-28% [2,3].…”

“…Neonatal appendicitis is exceedingly rare with an incidence of approximately 40 per 100,000 live births [1,2]. 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].…”

“…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].…”