Neonatal acute Appendicitis: A Diagnostic Challenge

Document Type : Case Report


1 Department of Maternal and Child, Hospital "Ramiro Priale Priale" EsSalud, Continental University, Perú

2 Department of Pathological Anatomy, Hospital "Ramiro Priale Priale" EsSalud, Continental University, Perú

3 Pediatric Surgery Service, Hospital "Ramiro Priale Priale" EsSalud, Continental University, Perú


Background: Neonatal acute apendicitis in the newborn is an extremely rare surgical entity, its incidence is 0.04% to 0.2%, and it represents a diagnostic challenge in this group of patients. For this reason, it is not usual to suspect this pathology when we are facing an acute neonatal abdomen; mostly there is a delay in diagnosis and management. And although the literature shows a decrease in mortality, it is still around 28% in some reviews.
Case report: We report a female neonate with complicated acute appendicitis, who at the beginning did not present evident symptoms and did not respond to medical management. On the sixth day, due to poor evolution, he was admitted to surgery with findings: free meconium in the abdominal cavity with a 1-cm-diameter punch-type perforation in the distal ileum (4 cm from the ileus-caecal valve), which was crushed with phlegmonous cecal appendix; Cecum and omentum with abundant fibrin around.
Conclusion: The timely diagnosis of acute appendicitis in neonates continues to represent a challenge for neonatologists. Due to its low frequency but high lethality, it should be considered as a diagnostic option against a baby with an acute abdomen that does not show clinical findings of frequent pathologies in addition to an unusual clinical course.


  1. Stiefel D, Stallmach T, Sacher P. Acute appendicitis in neonates: Complication or morbus sui generis? Pediatr Surg Int. 1998; 14(1-2):122-3.
  2. Karaman A, Çavuşoǧlu YH, Karaman I, Çakmak O. Seven cases of neonatal appendicitis with a review of the English language literature of the last century. Pediatr Surg Int. 2003; 19(11):707-9.
  3. Schorlemmer GR, Herbst Jr CA. Perforated neonatal apendicitis. South Med J. 1983; 76(4):536-7.
  4. Bax NMA, Pearse RG, Dommering N, Molenaar JC. Perforation of the appendix in the neonatal period. J Pediatr Surg. 1980; 15(2):200-2.
  5. Raveenthiran V. Neonatal appendicitis (Part 1): a review of 52 cases with abdominal manifestation. J Neonatal Surg. 2015; 4(1):1-7.
  6. Shommu NS, Jenne CN, Blackwood J, Joffe AR, Martin DA, Thompson GC, et al. Metabolomic and inflammatory mediator based biomarker profiling as a potential novel method to aid pediatric appendicitis identification. PLoS One. 2018; 13(3):1-13.
  7. Si SY, Guo YY, Mu JF, Yan CY. The sonographic features of neonatal apendicitis: a case report. Medicine. 2017; 96(45):10-2.