A RARE CASE OF NEONATAL CHRONIC SUPPURATIVE APPENDICITIS

PRESENTING WITH COMORBID OF INTESTINAL MALROTATION

Putu Pradnyanita Mustika*, Made Sukmawati*, I Wayan Dharma Artana*, I Made
Kardana*, Putu Junara Putra*, Made Dharmajaya**, Kadek Deddy Ariyanta**
*Departement of Child Health, **Departement of Child Surgical
Medical School of Udayana University, Sanglah Hospital, Denpasar, Bali

ABSTRACT

Objective: To describe a rare case of chronic suppurative appendicitis in neonate

presenting with a comorbid of intestinal malrotation.

Case: Seven days old boy neonate, had a complain of lethargic and hypoglycemia
since one days old. This complain was followed by bilious vomiting at four days old.
Physical examination revealed the abdomen was distended with difficulty to evaluate
liver and spleen. Bowel sound was decreased when auscultated. Laboratory and
radiologic examination was done. The investigation showed leucocytosis with
abdominal X-Ray found distribution of intestinal air in the gastric and duodenum part
3 with minimum air in the distal part of duodenum. The patient was suspected with
atresia or stenosis of distal duodenum or jejunum. Diagnosis of observation of
abdominal distention caused by total ileus obstruction suspect duodenum
malrotation part 2 was made and Ladd’s procedure was done.

During Ladd’s procedure, an appendix perforation was found. Instead of doing

inversion-ligation appendectomy to avoid contaminated surgery, resection of
appendix was done. The pathology anatomy examination revealed a chronic
suppurative appendicitis. Recumbent position, funnel-shape appendix of neonates
and milk as a soft diet are a protection factor against obstruction of appendix in
neonate. Therefore, it is rare if neonate has an appendicitis especially chronic
suppurative one. This patient was discharged in good condition twenty days after
surgery.

Conclusion: Neonatal appendicitis is a rare condition with nonspecific sign and

symptom compare to older children. In neonate, preoperative diagnosis is difficult to
make. This condition usually found accidentally during an operation with other
comorbid problem. Resection is the treatment of choice with an excellent outcome.

Keywords: neonatal appendicitis, intestinal malrotation and Ladd’s procedure