Not Like in the Textbook - Neonatal and Infant Appendicitis is a Challenging Diagnosis

Appendicitis is the most common condition requiring emergency surgery in pediatric patients. Despite this, appendicitis is exceedingly rare in neonatal and infant age groups. Neonatal appendicitis is difficult to diagnose as it mimics other more common abdominal pathologies.

A retrospective review from 2004 to 2024 of a quaternary pediatric hospital was conducted and included all infants under 1 y of age who underwent appendectomy and were found to have appendicitis on pathology. Patients were excluded if they had an appendectomy without pathology confirming appendicitis or no documentation of appendicitis. Data extracted included demographics, symptoms, labs, imaging, surgical, and pathological outcomes.

Seven patients presented with appendicitis with a median age of 14 d (interquartile range 8.5-45d). Five had comorbidities. The most common presentations were abdominal distension, pain, fever, and diarrhea. The average white blood cell count was 12.95 ± 6.42x10³ cells/μL. C-reactive protein and procalcitonin were elevated in both patients in which they were completed. Five of the patients had blood cultures, with two of the five positive for Escherichia coli. Most patients had an abdominal x-ray (n = 6) and two had free air. Two underwent abdominal ultrasound and one demonstrated an enlarged appendix. Three of the patients required more than one visit for definitive treatment. Two patients had laparoscopic procedures. Four of the patients had perforations. There was no mortality or complications related to surgery.

Neonatal and infant appendicitis at our institution was rare. There was no unifying presentation or symptomatology that was consistent across the patient cohort, which makes diagnosis challenging in this patient population.