Neonatal Appendicitis – an Uncommon Diagnosis, not to be Forgotten

Acute appendicitis is a common disease in older children, but extremely rare in the neonate. Nevertheless, the true incidence might be underestimated, given the difficulty of the diagnosis. Subtle clinical signs and symptoms usually result in high morbidity and mortality due to delayed diagnosis and surgical intervention. The presentation of neonatal appendicitis can be identical to necrotizing enterocolitis, leading to misdiagnosis. Appendicitis should therefore be considered in the differential diagnosis for necrotizing enterocolitis and needs strong clinical suspicion. We report a case of a premature newborn who presented with vomiting, abdominal distension and free intra-peritoneal air on plain x-ray. He was initially diagnosed and treated as necrotizing enterocolitis, but the absence of clinical improvement with standard treatment led to exploratory laparotomy. Surgical exploration revealed an acutely inflamed appendix with normal small and large intestines and appendectomy was performed. The post-operatory period was uneventful and the infant was discharged home. Follow-up confirmed a normal growth and neurodevelopment. We herein report this case in order to raise awareness to this unusual pathology, so that an early diagnosis and treatment can lead to a better outcome, improving survival rate and reducing long term morbidity. We believe uncommon pathologies, like neonatal appendicitis, should be reported to facilitate proper epidemiologic studies.