2019 - Appendicular Perforation in A Neonate
2019 - Appendicular Perforation in A Neonate
2019 - Appendicular Perforation in A Neonate
DOI: http://dx.doi.org/10.18203/2349-2902.isj20191913
Case Report
*Correspondence:
Dr. Santosh Kumar Singh,
E-mail: [email protected]
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ABSTRACT
Appendicitis and the consequent appendicular perforation are mostly rare in neonates. It is more common in
premature babies though. Presentation therefore may mimic necrotizing enterocolitis although this is usually not so
severe. We report a case of appendicular perforation in a term neonate who presented as peritonitis. Diagnosis was
made after the exploration. Patient did well after surgery. Although rare, appendicular pathology should be
entertained in any case of peritonitis even though the presentation is not the same as in older children due to various
anatomical reasons. Primary treatment is surgery.
Appendicitis remains the most common cause of acute A ten-day old full-term male baby delivered via LSCS
abdomen in children. However the condition is very rare presented with difficulty in breathing since five days and
in neonates with a high complication rate.1 Rarity of the abdominal distension since one day. Baby had passed
condition remains one of the reasons for late diagnosis. meconium within 24 hours of birth. There were no
Appendicular perforation in particular is a life threatening significant perinatal events.
condition in neonates and may be responsible for high
morbidity and mortality.1,2 A thin appendicular wall with On examination, baby had a toxic look, had tachypnoea
indistensible caecum in neonates predisposes to and tachycardia and was dehydrated. Abdomen was
appendicular perforation.3 Nevertheless perforation could distended, tense and tender, and shiny. Dilated veins
be the end result of another disease process as well like showed over the abdomen.
Hirschsprung’s disease, necrotising enterocolitis, cystic
fibrosis etc. Interestingly however, overall incidence of Hemogram showed neutrophilic leucocytosis.
neonatal appendicitis remains low (0.04-0.2%) and it is Electrolytes were within normal limits. Abdominal X-ray
little more in premature males although the reason for showed dilated bowel loops (Figure 1). USG abdomen
this is not known.4 A high index of suspicion is necessary largely corroborated the X-ray findings. There was no
therefore to make a preoperative diagnosis inasmuch as mass or local fluid collection.
the presentation is not classical. Treatment is surgical.
Prognosis depends on the gestational age, timing of With a working diagnosis of peritonitis, patient
diagnosis, presence of complications, and other co- underwent exploratory laparotomy. It showed bilio-
morbid factors. feculent free fluid in the abdominal cavity. There were
grade I adhesions present among the bowel loops which
were slightly edematous. There was a big perforation inflammation of appendix or could be the end result of
present at the base of the appendix. Adjacent ileum and another disease process like Hirschsprung’s disease,
caecum showed multiple tiny necrotic patches. necrotising entercolitis, and cystic fibrosis. A thin
Appendectomy was done. In view of the necrotic changes appendicular wall with indistensible cecum in neonates
at the ileo-cecal junction, latter was exteriorized. Gentle predisposes to appendicular perforation.3 Incidence
peritoneal lavage was done and abdomen was closed over reported is approximately 40 per 100,000 live births (0.04
a glove drain. Patient made good recovery. to 0.2%) and is more in premature male.4 Low Incidence
of neonatal appendicitis is attributed to funnel-shaped
appendix with wide opening of cecum, liquid diet and
lack of fecolith.5