perforated acute appendicitis in a pre-term neonate

acute appendicitis is a common occurrence in childhood, but this diagnosis is considered rarely in differential diagnosis of acute abdomen in the neonatal period because its occurrence is very rare in neonates. we report a 20-day- old afghan female baby that was admitted to neonatal intensive care unit, because of irritability and abdominal distension. complete ultrasound of abdomen and pelvis was normal. in plain radiographs of chest and abdomen with the exception of air-filled stomach and intestine, there was no abnormality. due to the lack of improvement and severe abdominal distension, she was transmitted to the operating room and surgical exploration revealed perforated appendix. appendicitis should be considered in the differential diagnosis for a neonate with abdominal distension and bilious vomiting and needs strong clinical suspicion.