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Neonatal perforated appendicitis: a presentation of necrotising enterocolitis?
Prathit Naik1, Rajendra Prasad Anne2, Sheila Samanta Mathai1
1Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
BMJ Case Reports
|November 9, 2023
Summary
A growth-restricted neonate with feeding intolerance was initially suspected of necrotizing enterocolitis. Surgical exploration revealed appendiceal perforation, leading to successful appendectomy and recovery.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Surgical pathology
Background:
- Late preterm infants with intrauterine growth restriction are at increased risk for gastrointestinal complications.
- Feeding intolerance is a common early sign of neonatal surgical emergencies.
Observation:
- A neonate presented with feeding intolerance progressing to peritonitis and perforation.
- Initial management for suspected necrotizing enterocolitis with flank drainage was unsuccessful.
Findings:
- Surgical exploration identified appendiceal perforation as the cause of peritonitis.
- Appendectomy was performed, with the remainder of the bowel appearing healthy.
- Histopathology confirmed transmural inflammation, infarction, and perforation of the appendix.
Implications:
- Appendiceal perforation should be considered in neonates with peritonitis, even with initial signs suggestive of necrotizing enterocolitis.
- Prompt surgical intervention can lead to favorable outcomes in neonates with appendiceal perforation.
- Accurate diagnosis and timely management are crucial for improving neonatal surgical outcomes.
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