Infantile Appendicitis – A Dangerous Disease That Should Be Considered

Aim: Acute Appendicitis is rare in infants. This disease has uncommon clinical course, and low specificity and sensitivity imaging and laboratory results. Since this is a life-threatening situation, which is commonly missed, we describe 3 infants.

Methods: Screening patients under 1-year-old with a diagnosis of acute or complicated appendicitis.

Results: Three patients 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.

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 discharged. A day later she returned to Pediatric Surgery due to high fever, restlessness, and constant right abdominal tenderness. Imaging demonstrated inflammation process at the right abdomen. She underwent laparoscopic appendectomy which confirmed diagnosis, Pseudomonas Aeruginosa discovered 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. He was treated successfully with percutaneous abscess drainage and antibiotics, intestinal flora was found. The infant underwent elective uneventful laparoscopic appendectomy two months later.

Conclusions: When a baby comes to our attention with an unclear infectious disease, we must remember that is possible, since missing this diagnosis can lead to high morbidity and mortality.