Appendicitis and its associated mortality and morbidity in infants up to 3 months of age:A systematic review

Background and Aims: Although appendicitis is rare in young infants, the reported mortality is high. Primary aim of this systematic review was to provide updated insights in the mortality and morbidity (postoperative complications, Clavien-Dindo grades I–IV) of appendicitis in infants ≤3 months of age. Secondary aims comprised the evaluation of patient characteristics, diagnostic work-up, treatment strategies, comorbidity, and factors associated with poor outcome. Methods: This systematic review was reported according to the PRISMA statement with a search performed in Pubmed, Embase and Web of Science (up to September 5th 2022). Original articles (published in English ≥1980) reporting on infants ≤3 months of age with appendicitis were included. Both patients with abdominal appendicitis and herniated appendicitis (such as Amyand's hernia) were considered. Data were provided descriptively. Results: In total, 131 articles were included encompassing 242 cases after identification of 4294 records. Overall, 184 (76%) of the 242 patients had abdominal and 58 (24%) had herniated appendicitis. Two-hundred (83%) of the patients were newborns (≤28 days) and 42 (17%) were infants between 29 days and ≤3 months of age. Either immediate, or after initial conservative treatment, 236 (98%) patients underwent surgical treatment. Some 168 (69%) patients had perforated appendicitis. Mortality was reported in 20 (8%) patients and morbidity in an additional 18 (8%). All fatal cases had abdominal appendicitis and fatal outcome was relatively more often reported in newborns, term patients, patients with relevant comorbidity, nonperforated appendicitis and those presented from home. Conclusion: Mortality was reported in 20 (8%) infants ≤3 months of age and additional morbidity in 18 (8%). All patients with fatal outcome had abdominal appendicitis. Several patient characteristics were relatively more often reported in infants with poor outcome and adequate monitoring, early recognition and prompt treatment may favour the outcome.</p

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

Disruption of RFX family transcription factors causes autism, attention-deficit/hyperactivity disorder, intellectual disability, and dysregulated behavior

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