Balachandra Thambirajah, Vadysinghe Amal N, Sergi Consolato M
Office of the Chief Medical Examiner, Edmonton, Alberta, Canada.
Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Case Rep Gastroenterol. 2022 Apr 21;16(1):258-263. doi: 10.1159/000524191. eCollection 2022 Jan-Apr.
Acute appendicitis (AA) in neonates and infants is an infrequent event. In day-to-day practice, death due to AA is hardly ever reported to a coroner or a medical examiner. Here, we report on an 8-month-old infant assigned to the medical examiner as the death occurred within 10 days of a surgical procedure. The cause of death was undetermined. Autopsy revealed gross and histologic features of AA. A postmortem review of the medical records showed signs and symptoms consistent with AA. On the other hand, a recent history of upper respiratory tract infection followed by clinical diagnosis and treatment by a community pediatrician probably blindsided the hospital physicians. This case illustrates the challenges of AA in infancy. The literature review revealed that a misdiagnosis of AA is more likely to occur on several occasions. They include patients who present "atypically," patients who are not thoroughly examined, patients receiving antipyretic or analgesic medication and discharged, those diagnosed as having gastroenteritis, and patients who do not receive an appropriate discharge or follow-up instructions.
新生儿和婴儿患急性阑尾炎（AA）的情况并不常见。在日常医疗实践中，因急性阑尾炎导致的死亡几乎从未报告给验尸官或法医。在此，我们报告一例8个月大的婴儿，其在外科手术后10天内死亡，被分配给法医进行检查。死因不明。尸检揭示了急性阑尾炎的大体和组织学特征。对病历的事后审查显示出与急性阑尾炎相符的体征和症状。另一方面，近期有上呼吸道感染病史，随后由社区儿科医生进行临床诊断和治疗，这可能使医院医生产生了疏忽。该病例说明了婴儿急性阑尾炎的挑战。文献综述显示，急性阑尾炎的误诊在多种情况下更有可能发生。这些情况包括表现“不典型”的患者、未接受全面检查的患者、接受退热或止痛药物治疗后出院的患者、被诊断为患有肠胃炎的患者，以及未收到适当出院或随访指示的患者。
