Infantile Appendicitis: A Dangerous Disease that should be Considered

Background: Acute Appendicitis is rare at toddlers and more so in infants. Mortality is up to 23% in neonates even today. This disease has uncommon clinical course, with relatively low specificity and sensitivity imaging and laboratory results.

Objective: Improve attention to this disease by describing 3 infants with this life-threatening situation that is commonly missed.

Methods: Screening patients under 1-year-old records during 1992-2018, with literature review.

Results: Three patients were found, ages 6 days to 4-months-old. The first 6-old-day neonate was operated due to duodenal obstruction. The duodenum was found to be obstructed by Ladd`s bands that covered peri-appendicular abscess compressing the duodenum. Appendectomy and Ladd`s procedure were performed. The pus revealed Escherichia Coli & Clostridium species.

The second 2-months-old infant was hospitalized for 3 days at Pediatrics with undiagnosed fever disease. After thorough investigation she received ceftriaxone for 2 days, clinically improved and was discharged. A day later she returned to Pediatric Surgery due to high fever, restlessness, anorexia and constant right abdominal tenderness on recurrent examinations. Imaging demonstrated unclear inflammation process at the right abdomen. She underwent laparoscopic appendectomy which confirmed appendicitis; Pseudomonas Aeruginosa was found at peritoneal culture.

The third 4-months-old infant was hospitalized at Pediatric Intensive Care Unit with a clinical picture of stormy compensated septic shock. The diagnosis of peri-appendicular abscess was revealed only after thorough investigation and recurrent imaging. He was treated successfully with antibiotics and percutaneous abscess drainage; intestinal flora was found in the pus. The infant still awaits elective laparoscopic appendectomy.

Conclusion: Appendicitis in infancy is rare, nonetheless hazardous situation. The scarce literature shows it clearly. When a baby comes to our attention with an unclear infectious disease, we must remember that appendicitis is possible, since missing this diagnosis can lead to high morbidity and mortality.