Neonatal and Infant Appendicitis.

Neonatal appendicitis is a rare disease with a high mortality rate. Appendicitis is difficult to diagnose in neonatal and infant populations because it mimics other more common conditions in these age groups. Furthermore, signs and symptoms of appendicitis are often nonspecific in nonverbal patients and a high index of suspicion is necessary to initiate the appropriate diagnostic work-up. The keys to successful management of appendicitis in infants include keeping the diagnosis on the differential in the setting of unexplained intra-abdominal sepsis, following a diagnostic algorithm in the work-up of infant abdominal pathology, and performing appendectomy once the diagnosis is confirmed.

Apendicitis abdominal neonatal. Experiencia en un hospital terciario y revisión de la literatura / Neonatal appendicitis. Our experience and review

Introducción: La apendicitis neonatal (AN) es una enfermedad poco frecuente, cuyo diagnóstico diferencial con otras entidades, como la enterocolitis necrosante, es muy difícil de realizar. Casos clínicos: Presentamos tres casos de AN en nuestro centro atendidos en los últimos 12 años. Resultados: Todos eran recién nacidos prematuros de menos de 1.500 g, con distensión abdominal y signos radiológicos de perforación. Todos sobrevivieron tras la realización de una laparotomía y una apendicectomía. No se encontraron en ningún caso otras enfermedades asociadas, como enfermedad de Hirschsprung (EH) o fibrosis quística (FQ). Conclusiones: La AN es un cuadro poco frecuente, y en nuestra experiencia no parece estar relacionado con la EH ni la FQ. Con un diagnóstico precoz, puede tener buen pronóstico (AU)

Introduction: Neonatal appendicitis (NA) is a rare disease, and differential diagnosis with necrotizing enterocolitis is hard to do. Clinical cases: We present three cases of NA found in our centre in the last 12 years. Results: All of them were premature infants less than 1,500 g, with physical findings of abdominal distention and perforation. All of them survived after laparotomy and appendectomy. No other diseases were associated (Hirschsprung disease, cystic fibrosis). Conclusions: We find neonatal appendicitis to be rare, and in our experience is not related to Hirschsprung disease or cystic fibrosis. With early diagnoses, prognosis seems to be good (AU)

Symptomatic Meckel's diverticulum in newborn: two interesting additional cases and review of literature.

OBJECTIVES: This study aimed to review the literature about symptomatic Meckel's diverticulum (MD) in the neonatal period with 2 additional uncommon cases. METHODS: The authors describe 2 interesting neonatal cases of symptomatic MD and analyze the literature on this topic, with particular reference to the prevalence of sex, age at presentation, most common signs and symptoms, treatment, histology, associated anomalies, and outcome. RESULTS: The first patient was a term newborn with bowel obstruction by a pseudocystic MD. The second patient was a preterm infant with double perforation of the MD and ileum. Literature search for published case reports and case series on this topic reveals only 18 cases of neonatal symptomatic MD. Males are more frequently involved than females, and even preterm infants may be affected. Bowel obstruction (58.3%) and pneumoperitoneum (33.3%) are the most frequent clinical manifestation. Acute inflammation of the MD is the prominent histopathological finding (75%), although it does not seem to be related with the presence of heterotopic tissue within the MD. Surgical treatment is essential. The association of neonatal symptomatic MD with other anomalies is exceptional but is otherwise life threatening despite surgery. CONCLUSIONS: Bowel obstruction and pneumoperitoneum are the most frequent clinical manifestations of symptomatic MD in the newborn. Surgery is required for a definitive diagnosis and successful outcome.

Neonatal acute appendicitis: a proposed algorithm for timely diagnosis.

BACKGROUND: Neonatal appendicitis (NA) is a rare disease with a high mortality. The diagnosis has never been reported preoperatively and is notoriously difficult to make. METHODS: Charts since 1995 were retrospectively reviewed for discharge or death diagnoses of appendicitis in neonates younger than 28 days. We report 3 cases of NA seen at our institution during this period. RESULTS: All 3 infants were previously well, born at term, and presented with signs consistent with abdominal sepsis. The first 2 diagnoses were not made until autopsy. The third case survived after having an urgent computed tomographic scan, exploratory laparotomy, and appendectomy. DISCUSSION: The literature summarizing common presenting features of NA is reviewed. We present an algorithm to guide the workup of these neonates to facilitate earlier diagnosis and potentially improve outcomes.

[Incidental finding of an acute appendicitis in a premature newborn with haematochezia]. / Zufallsbefund einer akuten Appendizitis bei einem Frühgeborenen mit Hämatochezie.

In newborns, acute appendicitis is a very rare condition associated with significant lethality. Due to mostly non-specific symptoms, it is difficult to find the correct diagnosis preoperatively. Interestingly, rectal bleeding as a clinical sign in neonatal appendicitis is very uncommon. Here, we report on a 4-day-old premature female newborn with rectal bleeding who, therefore, underwent laparotomy because of a suspected volvulus. Except for an acutely inflamed appendix, no other pathological findings were found intraoperatively, leading to appendectomy. Histological investigation of the specimen confirmed acute ulcero-phlegmonous appendicitis. Thus, the rectal bleeding can be attributed to erosions as part of the inflammatory changes in clinically apparent appendicitis. The postoperative course of the patient was unremarkable, in perticular, no further rectal bleeding episode was observed. In spite of the low incidence of neonatal appendicitis, it has to be included in the spectrum of differential diagnoses if unclear abdominal discomfort occurs and whenever non-specific clinical signs are found in newborns. Early surgical intervention is considered the curative treatment approach of choice and can, thus, contribute to a reduction of the potential complications.

Neonatal periappendicular abscess--updated treatment.

The authors present a case of periappendicular abscess in a 5-day-old full-term neonate. Prompt diagnosis enabled us to deliver conservative treatment followed by interval laparoscopic appendectomy, instead of a risky urgent laparotomy. This is the first description of an advanced imaging-guided drainage procedure, followed by minimal invasive surgery, for the treatment of periappendicular abscess at such a young age.

Acute appendicitis in a premature baby.

A case of acute appendicitis in a premature baby in whom diagnosis was suggested on plain films of the abdomen is presented. In this baby air in a hollow viscus suspected of being an enlarged appendix was the clue to diagnosis. The diagnostic dilemma of this rare and life-threatening condition in premature babies and newborns is underlined. The relevance of different imaging modalities and of different findings in this age group is discussed. Awareness of this rare condition and possible differential diagnosis in newborns and premature babies is stressed.

Prenatal appendiceal perforation: a case report.

A neonate is reported with the meconium cyst form of meconium peritonitis secondary to appendiceal perforation, which occurred prior to birth.