Neonatal Perforated Appendicitis

Abstract

Introduction: Neonatal perforated appendicitis is a rare condition associated with significant morbidity and mortality. The rarity of neonatal appendicitis together with lack of specific signs and low index of suspicion has led to delay in diagnosis and surgical intervention. Here we report an unusual case of neonatal perforated appendicitis mimicking volvulus neonatarum. Methods: Patient's case notes were reviewed, presenting history, clinical, diagnostic and intraoperative findings were analyzed. Case report: A baby girl, born at 31 weeks of gestation by normal delivery weighing 1.88 kg was referred to surgical team on the 5th day of life for persistent bilious ryles tube aspirate.On examination, abdomen was not distended, no visible peristalsis seen, abdominal wall appeared normal. Abdomen was not tense, no mass was palpable. No other systemic abnormalities were detected. Abdominal x-ray done revealed a gasless abdomen. The provisional diagnosis at that time was midgut volvulus.Based on our provisional diagnosis, patient was scheduled for an emergency laparatomy. Intraoperatively, there was no gush of air, peritoneal fluid was cloudy, no malrotation seen. On gross examination, small bowel appeared to be edematous, there was exudate and pus over the right illiac fossa. On further exploration, the appendix was located at the retrocecal position with perforation at the body and its base was healthy. Large bowel was of normal caliber. Appendicectomy and peritoneal lavage with warm saline was performed.Histopathological examination showed mucosal ulceration associated with transmural neutrophilic infiltration. The mucosal layer is intact. The histopathological diagnosis was acute suppurative appendicitis. Conclusion: Neonatal perforated appendicitis continues to be a diagnostic challenge and requires a strong clinical suspicion. This case illustrates an unusual manifestation of neonatal appendicitis in which the clinical and radiological features were those of midgut volvulus. This fortuitously led to emergency laparatomy which revealed the actual diagnosis.