Incidental finding of an acute appendicitis in a premature newborn with haematochezia

• Published in: Zentralblatt fur Chirurgie Vol. 134; no. 6; p. 557
• Main Authors: Sachwitz, D, Hass, H-J, Aumann, V, Herrmann, K, Krause, H
• Format: Journal Article
• Language: German
• Published: Germany 01.12.2009
• Subjects: Abdomen, Acute - congenital; Abdomen, Acute - diagnosis; Abdomen, Acute - surgery; Appendectomy - methods; Appendicitis - congenital; Appendicitis - diagnosis; Appendicitis - pathology; Appendicitis - surgery; Appendix - pathology; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage - congenital; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - pathology; Gastrointestinal Hemorrhage - surgery; Humans; Incidental Findings; Infant, Newborn; Infant, Premature, Diseases - diagnosis; Infant, Premature, Diseases - pathology; Infant, Premature, Diseases - surgery
• ISSN: 1438-9592
• DOI: 10.1055/s-0028-1098922

In newborns, acute appendicitis is a very rare condition associated with significant lethality. Due to mostly non-specific symptoms, it is difficult to find the correct diagnosis preoperatively. Interestingly, rectal bleeding as a clinical sign in neonatal appendicitis is very uncommon. Here, we report on a 4-day-old premature female newborn with rectal bleeding who, therefore, underwent laparotomy because of a suspected volvulus. Except for an acutely inflamed appendix, no other pathological findings were found intraoperatively, leading to appendectomy. Histological investigation of the specimen confirmed acute ulcero-phlegmonous appendicitis. Thus, the rectal bleeding can be attributed to erosions as part of the inflammatory changes in clinically apparent appendicitis. The postoperative course of the patient was unremarkable, in perticular, no further rectal bleeding episode was observed. In spite of the low incidence of neonatal appendicitis, it has to be included in the spectrum of differential diagnoses if unclear abdominal discomfort occurs and whenever non-specific clinical signs are found in newborns. Early surgical intervention is considered the curative treatment approach of choice and can, thus, contribute to a reduction of the potential complications.