Appendicitis in infants up to three months of age: A case series

Introduction: Appendicitis is rare in young infants and often not timely recognized due to non-specific symptoms. We aimed to increase awareness and contribute to current knowledge by presenting two cases. Case presentation: Case 1; a term boy presented at ten weeks of age with fever, vomiting and an enlarged translucent erythematous scrotum. The latter was interpreted as hydrocele and antibiotic treatment for suspicion of sepsis without patent source was started. Five days later, he developed abdominal distension and was transferred to our tertiary referral center. Imaging showed local pneumoperitoneum on ultrasound, and a covered intestinal perforation was suspected. Antibiotics were continued, obtained blood cultures were positive for Clostridium tertium. On day eight, ultrasound identified a tubular structure in the right lower quadrant. At laparotomy we found an interloop abscess in connection with the appendix and performed an appendectomy. The postoperative course was complicated by an intra-abdominal abscess, treated with antibiotics, with uneventful recovery thereafter. Case 2; a preterm girl (gestational age 24 weeks) developed abdominal distension at 11 days of age due to pneumoperitoneum. Laparotomy showed perforated appendicitis and a fibrinous exudate on the sigmoid. An appendectomy was performed, and a protective split ileostomy was created as a micro-perforation could not be excluded. The postoperative course was complicated by recurrent peristomal bullous impetigo and septic thrombophlebitis requiring antibiotic treatment, with uneventful recovery thereafter. Conclusion: Both cases underline that clinicians should include appendicitis in the differential diagnosis of young infants presenting with unexplained sepsis and/or gastrointestinal symptoms, despite the rare incidence.