Acute Abdomen in an Extremely Low-Birth-Weight Preterm Neonate: A Case of Appendicitis

Neonatal appendicitis is a very rare surgical entity. Non-specific symptoms such as feeding intolerance, abdominal distension, vomiting, increased gastric residue, lethargy, and fever may be present. The majority of reported cases could not be identified early. In this report, we present an extremely low-birth-weight preterm neonate who has been diagnosed with appendicitis.

A 980-gram preterm baby girl was born at 31 1/7 weeks of gestation. The physical examination was normal at birth. Her initial clinical course was uneventful. On the 7^th day of life, she developed abdominal distention and tenderness. She had an episode of bloody stools and bilious vomiting. An abdominal X-ray suggested localized perforation in the cecum with an air-fluid level in the right lower quadrant. The clinical findings suggested necrotizing enterocolitis and perforation, and a diagnostic laparotomy was performed. The bowel was found to be normal with a necrotic appendix. The appendectomy was performed. She was discharged from the neonatal intensive care unit with no complications.

Appendicitis is extremely rare in the neonatal period. It is quite challenging to evaluate the presentation accurately, which causes a delay in diagnosis. However, if an atypical NEC or peritonitis is present, appendicitis should be considered. Early diagnosis and timely surgical intervention improve the prognosis of neonatal appendicitis.