Acute perforated appendicitis with pre-surgical diagnosis and bilateral inguinal hernia in preterm infants

Background: Acute neonatal appendicitis is a rare pathology, with few reports in the last 30 years. Since its clinical presentation and imaging studies are non-specific, most cases are diagnosed during a surgical pro cedure.

Objective: To describe a neonatal case of acute perforated appendicitis associated with later appearance of inguinal hernia, with pre-surgical diagnosis and treated through laparoscopy.

Methods: A 17-day-old preterm female newborn presented with fever, irritability, and increased milk intolerance. Physical examination showed abdominal distention, tenderness and both, abdominal X- ray and ultrasound showed compatible images with acute perforated appendicitis. Once the diagnosis was confirmed, we performed an appendicectomy through laparoscopy. Two weeks later, during an outpatient visit, we observed a bilateral inguinal hernia which was confirmed by ultrasound, and then it was surgically corrected.

Conclusions: Acute appendicitis should be considered within the differential diagnosis in neonates with acute abdominal symptoms, mainly in premature infants. In this case, ultrasound scan allowed us to make the pre-operative diagnosis. The possible association with inguinal hernias should motivate to examine inguinal ducts during imaging assessment and surgical procedure.