A three-week-old preterm female infant with abdominal distension. Ruptured neonatal appendicitis

a three-week-old preterm female infant, cared for in the inten-sive care nursery, presented with abdominal distension. she was born at 31 weeks of gestation by a caesarean delivery and weighed 1330 grams. she had no major problems and received no respiratory support or supplemental oxygen. she underwent a sepsis work-up and received antibiotics for 10 days. she was started on total parenteral nutrition that was discontinued at the age of 2 weeks when she was fed fortified maternal milk exclusively. she had a few short episodes of apnea and mild physiologic hyperbilirubinemia that was treated with phototherapy. she was given aminophylline and vitamin d. suddenly, at the age of 3 weeks, she presented with abdominal dis-tension, with no vomiting and no gastric bilious residue. stools were negative for occult blood. she did not appear septic or in a state of shock. Preliminary studies and a plain radiograph of the abdomen were taken. The film was immediately available (Figure l).