2008, Number 1
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ABSTRACTAppendicitis in infants under 2 years of age is uncommon: only 2% of all cases. Its incidence is much lower in neonates, about 0.2% of all cases. Since the diagnosis is uncommon and hence unsuspected in this age group, treatment is often delayed, for which reason perforation and peritonitis is almost always present. In the differential diagnosis the etiology of this condition should include appendiceal inflammation secondary to distal colonic obstruction from Hirschsprung´s disease blockage, from internal or external hernias, appendicitis and perforation from meconium plugs, choriamnioitis, streptococal sepsis, cystic fibrosis and from necrotizing enterocolitis. The present case is an 8 days old febrile female who presented at the second day of life. The patient refused feeding; she had abdominal distention with shiny skin, very irritable. There were bloody stools. Abdomen was tender to palpations; bowel sounds were absent. A laparotomy was performed .There was free meconial fluid in the peritoneal cavity; the appendix was perforated; a 2 mm perforation was also present in the transverse colon. The perforation was closed and Oschner appendectomy was done followed by peritoneal lavage. Biopsies from the colon and the sigmoid were taken. The patient improved and began to tolerate formula. Stools became normal. She had been given cefotaxime, metronidazole and amikacin. The symptomatology of this condition is not revealing. The possibility of appendicitis should be suspected in an infant with an acute abdomen. Diagnosis requires a high index of suspicion. Early appendectomy before perforation occurs is the ideal treatment, but establishing a diagnosis in neonates is exceptional.
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