Perforated acute appendicitis with no peritonitis in a premature baby: a case report

BACKGROUND: 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. CASE PRESENTATION: 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. CONCLUSIONS: 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.