Neonatal acute Appendicitis: A Diagnostic Challenge

Background: Neonatal acute apendicitis in the newborn is an extremely rare surgical entity, its incidence is 0.04% to 0.2%, and it represents a diagnostic challenge in this group of patients. For this reason, it is not usual to suspect this pathology when we are facing an acute neonatal abdomen; mostly there is a delay in diagnosis and management. And although the literature shows a decrease in mortality, it is still around 28% in some reviews. Case report: We report a female neonate with complicated acute appendicitis, who at the beginning did not present evident symptoms and did not respond to medical management. On the sixth day, due to poor evolution, he was admitted to surgery with findings: free meconium in the abdominal cavity with a 1-cm-diameter punch-type perforation in the distal ileum (4 cm from the ileus-caecal valve), which was crushed with phlegmonous cecal appendix; Cecum and omentum with abundant fibrin around. Conclusion: The timely diagnosis of acute appendicitis in neonates continues to represent a challenge for neonatologists. Due to its low frequency but high lethality, it should be considered as a diagnostic option against a baby with an acute abdomen that does not show clinical findings of frequent pathologies in addition to an unusual clinical course.