Casal-Beloy I, García-González M, García-Novoa M A, Somoza Argibay I, Dargallo Carbonell T
Complejo Hospitalario Universitario A Coruña.
An Sist Sanit Navar. 2018 Aug 29;41(2):249-253. doi: 10.23938/ASSN.0292.
Appendicitis is the most frequent surgical disease in childhood, but it is very uncommon in the neonatal period. In this period of life, a delay in diagnosis (frequently due to the rareness of this pathology and lack of clinical suspicion) and consequently in therapeutic approach, frequently results in appendicular perforation and a subsequently poor evolution of this pathology. We present the case of a neonate with a history of Down's syndrome and Fallot's tetralogy. Due to her basal cardiopathy, she required surgical intervention to create a systemic-pulmonary fistula, as a temporary bridge until definitive cardiac surgery could be performed. In the postoperative period of this surgery she presented fever, acute abdomen and abdominal radiography compatible with pneumoperitoneum. An emergency laparotomy was performed, which revealed peritonitis secondary to a cecal gangrenous appendix with perforation in its middle third. Neonatal appendicitis is usually associated with diseases such as cystic fibrosis, necrotizing enterocolitis, or Hirschsprung's disease, as in the case of our patient. In neonates with acute abdomen and presence of pneumoperitoneum, appendicitis must be part of the differential diagnosis and requires urgent surgical intervention. Despite this, it presents a high rate of morbidity and mortality. Once the definitive diagnosis is made, any basal pathology that justifies its presence should be discarded.
阑尾炎是儿童时期最常见的外科疾病，但在新生儿期却非常罕见。在这个生命阶段，诊断延迟（通常是由于这种疾病罕见且缺乏临床怀疑）以及随之而来的治疗延迟，常常导致阑尾穿孔以及该疾病随后的不良进展。我们报告一例患有唐氏综合征和法洛四联症病史的新生儿病例。由于其基础心脏病，她需要进行手术干预以建立体肺分流，作为直到能够进行确定性心脏手术之前的临时桥梁。在该手术的术后期间，她出现发热、急腹症以及与气腹相符的腹部X线表现。进行了急诊剖腹手术，结果显示为盲肠坏疽性阑尾炎继发腹膜炎，穿孔位于阑尾中三分之一处。新生儿阑尾炎通常与诸如囊性纤维化、坏死性小肠结肠炎或先天性巨结肠病等疾病相关，就像我们的患者这种情况。对于有急腹症和气腹表现的新生儿，阑尾炎必须列入鉴别诊断范围，并且需要紧急手术干预。尽管如此，它的发病率和死亡率仍然很高。一旦做出明确诊断，任何能够解释其存在的基础疾病都应被排除。
