Radiological diagnosis of severe appendicitis in 4 months infant with possible microperforation: A rare case report

• Published in: Radiology case reports 2024-09, Vol.19 (9), p.3715-3718
• Main Authors: Ibdah, Mohammad G., Abu-Qare'e, Omar, Abdallah, Firas, Masalmeh, Leen Ibrahim Ahamd, Joma, Nataly, Al-Karaja, Layth, Awaysa, Asala M., Smerat, Mohammad I.
• Format: Article
• Language: English
• Subjects: Acute appendicitis; Case Report; Microperforation; Pediatric appendicitis; Ultrasonography
• ISSN: 1930-0433; 1930-0433
• DOI: 10.1016/j.radcr.2024.05.008

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention; however, it is extremely rare in infants. Its diagnosis and treatment are challenging due to nonspecific clinical signs and symptoms. As a result, delayed or missed diagnosis is common in young children and is associated with an increased risk of perforation and peritonitis. We reported a case of a 4-month-old healthy male child. The patient presented with abdominal distention and fever. After ruling out other possible causes, he was diagnosed with acute appendicitis, which was confirmed by a CT scan. A gangrenous appendix, dilated bowel loops, and free fluid in the abdomen were discovered during surgery. An appendectomy was performed. The appendix in infants has an average length of 4.5 cm compared with 9.5 cm in adults. Infantile appendicitis is considered rare but cases have been documented also in neonates, misdiagnosis rates are high due to rarity in this age group in addition to nonspecific signs and symptoms, which led to a high perforation rate. Ultrasonography can diagnose appendicitis in children with a sensitivity and specificity of 90%-95% without subjecting the child to radiation. A physician should always keep the diagnosis of appendicitis in mind in the infant age group, even though it is rare, as a delay in diagnosis and treatment has been associated with an increased risk of complications including appendicular perforation and peritonitis.