Appendicitis in infancy

A 3-Month-Old With Failure to Thrive and Persistent Vomiting

“…There is some thinking that neonatal appendicitis may represent a form of localized necrotizing enterocolitis 5 -9 because of common risk factors (including congenital heart disease and perinatal asphyxia), and it has been associated with Pseudomonas aeruginosa infection in some series. 10 It has been hypothesized that appendicitis is rare in this population because of the immature structure of the appendix during the neonatal period. Typically, the appendix has an overall funnel shape with a wider opening at the cecum, which differs from the more tubular structure seen in older patients.…”

“…Additionally, because infants are fed a liquid diet and generally remain in a supine position when either awake or asleep, they are less likely to develop symptomatic abdominal obstruction from any cause. 5,6,10 Neonates are also less likely to be infected with adenoviruses or other infections that may cause lymphoid hyperplasia, which is thought to be a contributing factor to the development of appendicitis in older patients. 5 Because of the difficulties in correctly identifying cases of neonatal appendicitis early, the risk of perforated appendicitis is higher, as was manifested in our patient's case.…”

Idiopathic Perforated Appendicitis in Neonates and Infants

“…Acute appendicitis, although common in adults and pediatrics, it is rare in neonates and infants. The rarity of appendicitis in neonates is due to the broad orifice (funnel-shape) of the appendix and a soft diet 7,8 . Patients below two years of age have three-times the risk of perforated appendix than an adult; the progression of the disease is rapid, and the presentation is atypical 9,10 .…”

A Newborn With Abdominal Pain

“…1, 3, 7 -10 Some speculate that the broadness of the appendix, or its conical shape, combined with the lack of fecaliths in neonates contributes to the rarity of this diagnosis. 7,9,[12][13][14] Anatomically, the neonate's appendiceal wall is thinner and perhaps more easily perforated. 7,9,15,16 The high morbidity and mortality rate could be attributed to faster progression to perforation, peritonitis, and subsequently septic shock.…”