Haider Fayza, Ayoub Barrak, Al Kooheji Mariam, Al Juffairi Mona, Al-Shaikh Safa
Department of Surgery-Pediatric Surgery Unit, Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain.
Department of Pediatrics, Salmaniya Medical Complex, Manama, Bahrain.
J Med Case Rep. 2017 May 5;11(1):125. doi: 10.1186/s13256-017-1289-0.
Acute appendicitis in a neonate and premature baby is still considered a rare entity as diagnosis is always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis. Our reported case is a premature baby who had a perforated appendix with no evidence of peritonitis.
We describe the case of a premature Bahraini girl born at 29 weeks of gestation by spontaneous vaginal delivery to a 39-year-old G6P5 mother. She was kept on a ventilator for the first 6 days of life, and had an uneventful Neonatal Intensive care stay until her 47th day of life when she developed sepsis that required ventilator support for 3 days. At day 51 she developed abdominal distension and was referred to a pediatric surgeon by day 54 with pneumoperitoneum. Her abdomen was soft with minimal tenderness and no evidence of erythema or edema. In view of pneumoperitoneum and previously reported sepsis, she was taken for exploratory laparotomy. The findings were consistent with a perforated appendix with no evidence of peritonitis or necrotizing enterocolitis. An appendectomy was performed. She had a smooth postoperative recovery.
Neonatal appendicitis continues to be a diagnostic challenge. Only with a high index of clinical suspicion and teamwork can these cases be managed successfully and mortality and morbidity rates may reduce.
新生儿和早产儿急性阑尾炎仍被视为罕见病症，因为其诊断总是在因类似坏死性小肠结肠炎的急性腹部表现而进行手术探查后才能做出。我们报告的病例是一名早产儿，其阑尾穿孔但无腹膜炎迹象。
我们描述了一名巴林早产女婴的病例，该女婴在孕29周时通过自然阴道分娩出生，母亲为一名39岁、孕6产5的女性。她出生后的前6天使用呼吸机，在新生儿重症监护室期间情况平稳，直到出生后第47天出现败血症，需要呼吸机支持3天。在第51天，她出现腹胀，到第54天因气腹被转诊给一名小儿外科医生。她的腹部柔软，压痛轻微，没有红斑或水肿迹象。鉴于气腹和先前报告的败血症，她接受了剖腹探查术。检查结果与阑尾穿孔相符，没有腹膜炎或坏死性小肠结肠炎的迹象。进行了阑尾切除术。她术后恢复顺利。
新生儿阑尾炎仍然是一个诊断难题。只有具备高度的临床怀疑指数并通过团队协作，才能成功处理这些病例，并可能降低死亡率和发病率。
