P3.M242: Acute appendicitis in an infant: Case report

Introduction: Appendicitis is most frequently encountered as the primary surgical issue among children, typically manifesting in the second decade of life. Although rare in infants, diagnosing appendicitis in this age group presents notable challenges, often leading to delayed identification and subsequent complications like perforation and abscess formation.

Case Description: A 3-month-old male presented with a 2-day history of vomiting, irritability, decreased oral intake, and reduced urine output. In the emergency room, he exhibited fever and received normal saline bolus for dehydration before admission. On admission, his vital signs were stable, and his abdomen appeared soft, non-distended, and non-tender, with normal bowel sounds. CBC revealed an elevated white blood cell count, and an abdominal X-ray showed gaseous distension and ileus. The patient was kept NPO, and blood and urine cultures were obtained. Patient experienced intermittent episodes of extreme fussiness and crying, prompting two abdominal ultrasounds, which suggested intussusception. However, contrast enema returned normal results, leading to the conclusion that the intussusception had spontaneously resolved. On day 2 of admission, pt. had ongoing fussiness with associated abdominal distension/tenderness. CT abdomen was done which revealed ruptured appendix with generalized peritonitis, necessitating appendectomy. The procedure was successful, without post-operative complications. Blood culture also resulted positive for E.coli. Patient was discharged home after completing the IV antibiotic course for E.coli bacteremia.

Discussion: Acute appendicitis is the leading reason for emergent pediatric abdominal surgery, predominantly affecting individuals aged 10-19 years. While it's infrequent in infants, diagnosing it poses unique challenges due to the presentation of nonspecific symptoms. Imaging techniques such as ultrasound and computed tomography assist in diagnosis, although their accuracy can be affected by factors like operator skill and anatomical variations. Complications, notably perforation, are more prevalent in infants due to delays in diagnosis. Early identification is vital to prevent adverse outcomes and ensure timely intervention.

Conclusion: Clinicians must maintain a high index of suspicion for acute appendicitis in neonates or infants exhibiting nonspecific abdominal symptoms. This vigilance is crucial to avoid delayed diagnosis, inappropriate treatment, and the resultant rise in morbidity and mortality.