Acute Neonatal Appendicitis: A Report of a Complicated Case in the Neonatal Intensive Care Unit

Abstract

Introduction: Neonatal appendicitis is an extremely rare and potentially serious condition, whose nonspecific clinical presentation hinders timely diagnosis and is associated with a high rate of intestinal perforation. Clinical overlap with common neonatal conditions, such as sepsis or necrotizing enterocolitis, poses a significant diagnostic challenge.

Case Presentation: We describe the case of a full-term newborn with intrauterine growth restriction who was admitted with suspected early neonatal sepsis. During her course, she presented with progressive abdominal distension, episodes of apnea, hemodynamic instability, and a marked elevation in inflammatory markers, with a blood culture positive for Escherichia coli. She subsequently developed bilious vomiting and increased abdominal distension, leading to an exploratory laparotomy, which identified a hyperemic retrocecal appendix with perforation in the middle third, confirming acute perforated appendicitis. An appendectomy was performed, and targeted antimicrobial therapy and intensive supportive care were initiated, with a favorable clinical outcome.

Conclusion: Neonatal appendicitis should be considered in the differential diagnosis of acute abdomen in the newborn, especially in the presence of progressive abdominal distension, bilious vomiting, or clinical deterioration without apparent cause. Early suspicion, timely surgical intervention, and comprehensive multidisciplinary management are critical for improving the prognosis.