Journal of Pediatric Surgery Case Reports · Published 2026-07-27 · DOI 10.1016/j.epsc.2026.103317
Mahdi Savadi, Marjan Joudi, Paria Dehghanian, Afsaneh Hokmabadi, Hossein Savadi
Introduction: Neonatal appendicitis is an extremely rare and potentially fatal condition, particularly in preterm infants, and is frequently misdiagnosed owing to its nonspecific clinical presentation. Delayed diagnosis contributes significantly to high rates of perforation and associated mortality. Case presentation: A 2-month-old male infant, born at 28 weeks of gestation with a birth weight of 990 g, presented with abdominal distension, non-bilious vomiting, absence of defecation, and systemic features of sepsis. Physical examination revealed severe abdominal distension and an incarcerated inguinal hernia. The infant was admitted with a diagnosis of intestinal obstruction secondary to the incarcerated hernia; manual reduction was attempted but unsuccessful. Laboratory investigations demonstrated a marked inflammatory response, metabolic acidosis, and coagulopathy. Imaging studies showed generalized bowel distension but did not identify the appendiceal pathology within the hernia sac. Emergency exploratory laparotomy, undertaken through a supraumbilical incision to allow comprehensive abdominal exploration given the severity of peritonitis, revealed an inflamed and perforated appendix within the inguinal hernia sac (Amyand's hernia), confirming a perforated appendix with associated peritonitis. Appendectomy and peritoneal lavage were performed successfully. Histopathological examination confirmed acute gangrenous perforated appendicitis with intact ganglion cells. The patient recovered uneventfully with gradual resumption of enteral feeding. Conclusion: Appendicitis, although rare, should be included in the differential diagnosis of preterm newborns who develop peritonitis and intestinal obstruction.
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Savadi, M., Joudi, M., Dehghanian, P., et al. (2026). Perforated neonatal appendicitis in an extremely preterm infant: A case report. Journal of Pediatric Surgery Case Reports. https://doi.org/10.1016/j.epsc.2026.103317