Neonatal appendicitis: a new look at an old zebra


      Acute neonatal appendicitis is a rare condition associated with significant morbidity and mortality. The severity of this disease is caused by its tendency to occur more frequently in premature infants, an increased perforation rate with rapid progression to peritonitis, and delay in diagnosis and intervention. Although appendicitis in the perinatal period may occur as an isolated event, in many cases it occurs in association with other pathologic states, including prematurity, inguinal hernia, and others. The presentation of neonatal appendicitis can be identical to necrotizing enterocolitis, leading to misdiagnosis. Here we report a case of perforated appendicitis in a 9-day-old boy with tetralogy of Fallot and esophageal atresia with tracheoesophageal fistula. In addition, we present a review of the clinical features of neonatal appendicitis and a discussion of previously described, associated conditions.

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        • Karaman A.
        • Cavusoglu Y.H.
        • Karaman I.
        • et al.
        Seven cases of neonatal appendicitis with a review of the English language literature of the last century.
        Pediatr Surg Int. 2003; 19: 707-709
        • Kwong M.S.
        • Dinner M.
        Neonatal appendicitis masquerading as necrotizing enterocolitis.
        J Pediatr. 1980; 96: 917-918
        • Lin Y.L.
        • Lee C.H.
        Appendicitis in infancy.
        Pediatr Surg Int. 2003; 19: 1-3
        • Stiefel D.
        • Stallmach T.
        • Sacher P.
        Acute appendicitis in neonates: complication or morbus sui generis?.
        Pediatr Surg Int. 1998; 14: 122-123
        • Bax N.M.
        • Pearse R.G.
        • Dommering N.
        • et al.
        Perforation of the appendix in the neonatal period.
        J Pediatr Surg. 1980; 15: 200-202
        • Buntain W.L.
        Neonatal appendicitis mistaken for necrotizing enterocolitis.
        South Med J. 1982; 75: 1155
        • Martins J.L.
        • Peterlini F.L.
        • Martins E.C.
        Neonatal acute appendicitis: a strangulated appendix in an incarcerated inguinal hernia.
        Pediatr Surg Int. 2001; 17: 644-645
        • Srouji M.N.
        • Buck B.E.
        Neonatal appendicitis: ischemic infarction in incarcerated inguinal hernia.
        J Pediatr Surg. 1978; 13: 177-179
        • Beluffi G.
        • Alberici E.
        Acute appendicitis in a premature baby.
        Eur Radiol. 2002; 12: S152-S154
        • van Veenendaal M.
        • Plotz F.B.
        • Nikkels P.G.
        • et al.
        Further evidence for an ischemic origin of perforation of the appendix in the neonatal period.
        J Pediatr Surg. 2004; 39: e11-e12
        • Arliss J.
        • Holgersen L.O.
        Neonatal appendiceal perforation and Hirschsprung's disease.
        J Pediatr Surg. 1990; 25: 694-695
        • Franklin A.J.
        • Glaysher C.
        Acute appendicitis presenting as gastroenteritis in an infant.
        Br J Clin Pract. 1973; 27: 21-22
        • Martin L.W.
        • Perrin E.V.
        Neonatal perforation of the appendix in association with Hirschsprung's disease.
        Ann Surg. 1967; 166: 799-802
        • Karaman A.
        • Cavusoglu Y.H.
        • Erdogan D.
        • et al.
        Appendiceal mass in a neonate after surgery for esophageal atresia and tracheoesophageal fistula: report of a case.
        Surg Today. 2005; 35: 80-81
        • Nichol P.F.
        • Corliss R.F.
        • Rajpal S.
        • et al.
        Perforation of the appendix from intestinal mucormycosis in a neonate.
        J Pediatr Surg. 2004; 39: 1133-1135
        • Pathania O.P.
        • Jain S.K.
        • Kapila H.
        • et al.
        Fatal neonatal perforation of appendix.
        Indian Pediatr. 1989; 26: 1166-1167
        • Swamy M.
        • Pejaver R.K.
        • Babu A.
        • et al.
        Appendicular perforation in necrotising enterocolitis.
        Indian Pediatr. 1998; 35: 59-61
        • Terry N.E.
        • Fowler C.L.
        Cytomegalovirus enterocolitis complicated by perforated appendicitis in a premature infant.
        J Pediatr Surg. 2006; 41: 1476-1478
        • Gastrin U.
        • Josephson S.
        Appendiceal peritonitis and megacolon in the neonatal period.
        Acta Chir Scand. 1970; 136: 153-155
        • Giacomoni M.A.
        • Manzoni G.A.
        • Volpi M.L.
        Perforated appendicitis in a newborn infant associated with Down's syndrome. Review of the literature.
        Pediatr Med Chir. 1986; 8: 113-114
        • Grosfeld J.L.
        • Weinberger M.
        • Clatworthy Jr, H.W.
        Acute appendicitis in the first two years of life.
        J Pediatr Surg. 1973; 8: 285-293
        • Iuchtman M.
        • Kirshon M.
        • Feldman M.
        Neonatal pyoscrotum and perforated appendicitis.
        J Perinatol. 1999; 19: 536-537
        • Lodha A.
        • Wales P.W.
        • James A.
        • et al.
        Acute appendicitis with fulminant necrotizing fasciitis in a neonate.
        J Pediatr Surg. 2003; 38: E5-E6
        • Managoli S.
        • Chaturvedi P.
        • Vilhekar K.Y.
        • et al.
        Perforated acute appendicitis in a term neonate.
        Indian J Pediatr. 2004; 71: 357-358
        • Neve R.
        • Quenville N.F.
        Appendicitis with perforation in a 12-day-old infant.
        Can Med Assoc J. 1966; 94: 447-448
        • Pressman A.
        • Kawar B.
        • Abend M.
        • et al.
        Acute perforated neonatal appendicitis associated with chorioamnionitis.
        Eur J Pediatr Surg. 2001; 11: 204-206
        • Ruff M.E.
        • Southgate W.M.
        • Wood B.P.
        Radiological case of the month. Neonatal appendicitis with perforation.
        Am J Dis Child. 1991; 145: 111-112
        • Trojanowski J.Q.
        • Gang D.L.
        • Goldblatt A.
        • et al.
        Fatal postoperative acute appendicitis in a neonate with congenital heart disease.
        J Pediatr Surg. 1981; 16: 85-86
        • Tucci P.
        • Holgersen L.
        • Doctor D.
        • et al.
        Congenital ureteropelvic junction obstruction associated with unsuspected acute perforated appendicitis in a neonate.
        J Urol. 1978; 120: 247-248