Download PDF
Am J Perinatol 2015; 32(07): 683-688
DOI: 10.1055/s-0034-1393934
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neonatal Vermiform Appendicopathy

Bengt-Ola S. Bengtsson
1   Pediatrix Medical Group of California Neonatal Intensive Care unit, Community Memorial Hospital of San Buenaventura, Ventura, California
2   College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
,
John P. van Houten
1   Pediatrix Medical Group of California Neonatal Intensive Care unit, Community Memorial Hospital of San Buenaventura, Ventura, California
2   College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
› Author Affiliations
Further Information

Publication History

28 May 2014

28 August 2014

Publication Date:
06 October 2014 (online)

    Permissions and Reprints

Abstract

Objective A neonate with a perforated appendix vermiformis in our neonatal intensive care unit (NICU) (case 1) prompted us to review our cases of exploratory laparotomy due to spontaneous intestinal perforation (SIP), surgical necrotizing enterocolitis (NEC), and other neonatal abdominal emergencies to identify additional cases of pathological appendiceal involvement (appendicopathy).

Methods A retrospective chart review was done for all the cases of exploratory laparotomy in our 16-bed community level-3 NICU between June 2003 and May 2014.

Results A total of 34 patients with exploratory laparotomies were identified. Among the 11 cases with histopathology of the appendix available, only 3 cases had appendicopathy. Of these, only one was conclusive regarding the etiology.

Conclusions A perforated and/or inflamed appendix does not equal a diagnosis of true appendicitis. The term appendicopathy is in our opinion, therefore preferable because it can be either primary or secondary to more common diagnoses, such as NEC and SIP. The possibility of perforation of the appendix must be considered in all cases of appendicopathy but this diagnosis is difficult to make. Once appendicopathy is found, attempts should be made to identify its etiology to optimize treatment and prognosis. We thus propose an etiologic classification of neonatal appendicopathy.

Keywords

appendicitis - appendicopathy - neonate - NEC - SIP
 

  • References

  • 1 Gordon PV, Swanson JR, Attridge JT, Clark R. Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria?. J Perinatol 2007; 27 (11) 661-671
    CrossrefPubMedGoogle Scholar
  • 2 Adesanya OA, O'Shea TM, Turner CS, Amoroso RM, Morgan TM, Aschner JL. Intestinal perforation in very low birth weight infants: growth and neurodevelopment at 1 year of age. J Perinatol 2005; 25 (9) 583-589
    CrossrefPubMedGoogle Scholar
  • 3 Blakely ML, Lally KP, McDonald S , et al; NEC Subcommittee of the NICHD Neonatal Research Network. Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network. Ann Surg 2005; 241 (6) 984-989 , discussion 989–994
    CrossrefPubMedGoogle Scholar
  • 4 Schwartz KL, Gilad E, Sigalet D, Yu W, Wong AL. Neonatal acute appendicitis: a proposed algorithm for timely diagnosis. J Pediatr Surg 2011; 46 (11) 2060-2064
    CrossrefPubMedGoogle Scholar
  • 5 Cherniavsky E, Crystal P, Barki Y. Sonography of acute appendicitis in a 9-month-old infant. J Ultrasound Med 2004; 23 (6) 865-867
    PubMedGoogle Scholar
  • 6 Mazeh H, Bar-Oz B, Vromen A. Appendiceal necrosis and pneumatosis as part of necrotizing enterocolitis. Isr Med Assoc J 2008; 10 (6) 479-480
    PubMedGoogle Scholar
  • 7 Arliss J, Holgersen LO. Neonatal appendiceal perforation and Hirschsprung's disease. J Pediatr Surg 1990; 25 (6) 694-695
    CrossrefPubMedGoogle Scholar
  • 8 Stiefel D, Stallmach T, Sacher P. Acute appendicitis in neonates: complication or morbus sui generis?. Pediatr Surg Int 1998; 14 (1-2) 122-123
    CrossrefPubMedGoogle Scholar
  • 9 Shah TA, Meinzen-Derr J, Gratton T , et al. Hospital and neurodevelopmental outcomes of extremely low-birth-weight infants with necrotizing enterocolitis and spontaneous intestinal perforation. J Perinatol 2012; 32 (7) 552-558
    CrossrefPubMedGoogle Scholar
  • 10 Lee CC, Lien R, Chiang MC , et al. Clinical impacts of delayed diagnosis of Hirschsprung's disease in newborn infants. Pediatr Neonatol 2012; 53 (2) 133-137
    CrossrefPubMedGoogle Scholar
  • 11 Karaman A, Cavuşoğlu YH, Karaman I, Cakmak O. Seven cases of neonatal appendicitis with a review of the English language literature of the last century. Pediatr Surg Int 2003; 19 (11) 707-709
    CrossrefPubMedGoogle Scholar
  • 12 van Veenendaal M, Plötz FB, Nikkels PGJ, Bax NMA. Further evidence for an ischemic origin of perforation of the appendix in the neonatal period. J Pediatr Surg 2004; 39 (8) e11-e12
    PubMedGoogle Scholar
  • 13 Jancelewicz T, Kim G, Miniati D. Neonatal appendicitis: a new look at an old zebra. J Pediatr Surg 2008; 43 (10) e1-e5
    PubMedGoogle Scholar
  • 14 Bax NMA, Pearse RG, Dommering N, Molenaar JC. Perforation of the appendix in the neonatal period. J Pediatr Surg 1980; 15 (2) 200-202
    CrossrefPubMedGoogle Scholar
  • 15 Shaul WL. Clues to the early diagnosis of neonatal appendicitis. J Pediatr 1981; 98 (3) 473-476
    CrossrefPubMedGoogle Scholar
  • 16 Beluffi G, Alberici E. Acute appendicitis in a premature baby. Eur Radiol 2002; 12 (Suppl. 03) S152-S154
    PubMedGoogle Scholar
  • 17 Stormer E, Gould S, Platt K, Lakhoo K. Necrotizing enterocolitis – a cause for neonatal perforated appendicitis. Infant 2007; 3: 109-110
    PubMedGoogle Scholar
  • 18 Schorlemmer GR, Herbst Jr CA. Perforated neonatal appendicitis. South Med J 1983; 76 (4) 536-537
    CrossrefPubMedGoogle Scholar
  • 19 Martin LW, Perrin EV. Neonatal perforation of the appendix in association with Hirschsprung's disease. Ann Surg 1967; 166 (5) 799-802
    CrossrefPubMedGoogle Scholar
  • 20 Narasimharao KL, Mitra SK, Pathak IC. Antenatal appendicular perforation. Postgrad Med J 1987; 63 (745) 1001-1003
    CrossrefPubMedGoogle Scholar
  • 21 Martin LW, Glen PM. Prenatal appendiceal perforation: a case report. J Pediatr Surg 1986; 21 (1) 73-74
    CrossrefPubMedGoogle Scholar
  • 22 Pressman A, Kawar B, Abend M, Steiner Z, Mogilner G. Acute perforated neonatal appendicitis associated with chorioamnionitis. Eur J Pediatr Surg 2001; 11 (3) 204-206
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Terry NE, Fowler CL. Cytomegalovirus enterocolitis complicated by perforated appendicitis in a premature infant. J Pediatr Surg 2006; 41 (8) 1476-1478
    CrossrefPubMedGoogle Scholar
  • 24 Nichol PF, Corliss RF, Rajpal S, Helin M, Lund DP. Perforation of the appendix from intestinal mucormycosis in a neonate. J Pediatr Surg 2004; 39 (7) 1133-1135
    CrossrefPubMedGoogle Scholar
  • 25 Martins JL, Peterlini FL, Martins ECS. Neonatal acute appendicitis: a strangulated appendix in an incarcerated inguinal hernia. Pediatr Surg Int 2001; 17 (8) 644-645
    CrossrefPubMedGoogle Scholar
  • 26 Iuchtman M, Kirshon M, Feldman M. Neonatal pyoscrotum and perforated appendicitis. J Perinatol 1999; 19 (7) 536-537
    CrossrefPubMedGoogle Scholar
  • 27 Kumar R, Mahajan JK, Rao KL. Perforated appendix in hernial sac mimicking torsion of undescended testis in a neonate. J Pediatr Surg 2008; 43 (4) e9-e10
    PubMedGoogle Scholar
  • 28 Nagel P. Scrotal swelling as the presenting symptom of acute perforated appendicitis in an infant. J Pediatr Surg 1984; 19 (2) 177-178
    CrossrefPubMedGoogle Scholar
  • 29 Baeza-Herrera C, García-Cabello LM, León-Cruz A, Martínez-Rivera MdeL. Torsion of the vermiform appendix associated with intussusception [in Spanish]. Cir Cir 2006; 74 (5) 369-371
    PubMedGoogle Scholar
  • 30 Lowry WL, Redman JF. Torsion of vermiform appendix: cause of acutely painful scrotum. Urology 1986; 28 (2) 117-118
    CrossrefPubMedGoogle Scholar
  • 31 Perger L, Muensterer OJ. Laparoscopic appendectomy for torsed appendix presenting as an acute abdomen in an infant female. JSLS 2011; 15 (4) 565-567
    CrossrefPubMedGoogle Scholar
  • 32 Jahangiri M, Hosseinpour M, Jazayeri H, Mohammadzadeh M, Motaharizad D, Mirzadeh AS. Perforated acute appendicitis in a pre-term neonate. Iran Red Crescent Med J 2013; 15 (6) 497-499
    CrossrefPubMedGoogle Scholar
  • 33 Khan YA, Zia K, Saddal NS. Perforated neonatal appendicitis with pneumoperitoneum. APSP J Case Rep 2013; 4 (2) 21
    PubMedGoogle Scholar