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Perforated appendicitis in a 4-month-old infant
1Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan, R.O.C.
Insights
Infantile appendicitis, though rare, presents diagnostic challenges and often leads to perforation. Early recognition and prompt surgical intervention are crucial for favorable outcomes in infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Appendicitis in infants is uncommon.
- Infantile appendicitis frequently presents with perforation and peritonitis.
- Clinical manifestations are often nonspecific, complicating diagnosis.
Observation:
- A 4-month-old infant presented with poor feeding and abdominal distention.
- Initial labs showed normal leukocyte counts but markedly elevated C-reactive protein.
- Progressive distention, bilious vomiting, and imaging findings suggested intestinal perforation.
Findings:
- Emergency laparotomy revealed perforated appendicitis with generalized peritonitis.
- Pseudomonas aeruginosa was identified, sensitive only to Ceftazidime.
- The infant recovered after a 2-week course of triple antibiotics.
Implications:
- This case highlights the diagnostic difficulties of appendicitis in very young infants.
- Prompt surgical management is vital for perforated appendicitis in neonates and infants.
- Aggressive antibiotic therapy targeting resistant organisms is essential for managing peritonitis.
Abstract:
A 4-month-old male infant was admitted to our hospital because of poor intake and mild abdominal distention for 1 day. Fever and watery diarrhea had occurred 4 days prior to admission, but subsided 2 days later after taking oral medications. A physical examination showed an acute ill-looking baby with a soft and mildly distended abdomen. The bowel sound was hypoactive and no obvious abdominal tenderness was found. Normal leukocyte and differential counts were noted in initial laboratory examinations; however, the serum level of C reactive protein was extremely high (31.4 mg/dL). Progressive abdominal distention and bilious vomiting occurred. Serial plain films of abdomen showed ileus with a fixed gas pattern and an abdominal echo revealed intraperitoneal fluid accumulation. Under the impression of intestinal perforation, an emergency laparotomy was performed. A perforated appendicitis with turbid fluid in the peritoneal cavity was noted during surgery. A pus culture grew Pseudomonas aeruginosa which was sensitive to Ceftazidime only. Triple antibiotics consisting of Prostaphlin, Metronidazole, and Ceftazidime were administered for 2 weeks. The patient was discharged 3 weeks later without any complications. Appendicitis in infancy is a rare condition and associated with a high frequency of perforation and peritonitis. Diagnosis is often difficult because of variable and nonspecific clinical manifestations.