Doctors Report Rare Case of Perforated Appendicitis Successfully Treated in a Two-Month-Old Infant
Greece: A rare case report published in the Cureus Journal of Medical Science has highlighted the diagnostic challenges of infantile appendicitis and demonstrated the successful use of minimally invasive surgery in a critically ill two-month-old infant. The report suggests that although appendicitis is exceptionally uncommon during early infancy, prompt recognition and surgical intervention can lead to favorable outcomes.
The case was described by Zoi Lamprinou and colleagues from the Pediatric Surgery Department at Panagiotis & Aglaia Kyriakou Children's Hospital.
Appendicitis is a common surgical emergency in older children and adults, but is exceedingly rare in infants, making diagnosis particularly difficult. Symptoms are often nonspecific and can mimic more common pediatric illnesses, leading to delays in identification and treatment. Delayed diagnosis may result in complications such as perforation and generalized peritonitis.
The reported case involved a two-month-old boy who presented with a six-hour history of fever, irritability, and repeated episodes of vomiting. Before symptom onset, he had been feeding normally but had not passed stool for two days. Initial examination revealed mild abdominal distension and generalized abdominal tenderness, while laboratory tests showed elevated procalcitonin and lactate levels despite normal inflammatory markers.
Initial imaging did not identify the cause of the infant’s symptoms. Abdominal radiography ruled out bowel obstruction and pneumoperitoneum, while ultrasound excluded pyloric stenosis and intussusception. Although gastroenteritis was initially suspected due to persistent fever and diarrhea, rising inflammatory markers prompted further evaluation.
Repeat ultrasound findings suggested perforated appendicitis with peritonitis, leading to urgent surgery. Diagnostic laparoscopy revealed diffuse purulent peritonitis, a gangrenous perforated appendix, an intraperitoneal appendicolith, and multiple collections of infected fluid within the abdominal cavity.
A laparoscopic appendectomy was successfully completed without conversion to open surgery. The appendiceal stump was reinforced with sutures, the abdominal cavity was thoroughly irrigated, and a drain was placed. The procedure was completed with minimal blood loss.
Following surgery, the infant received intravenous broad-spectrum antibiotics for 10 days and showed steady clinical improvement. Feeding was gradually resumed after 48 hours, and the patient was discharged on postoperative day 10. Follow-up at two and four weeks revealed normal growth and development without complications.
The authors noted that infantile appendicitis is a rare but potentially life-threatening condition that is often difficult to diagnose because of its nonspecific presentation, underscoring the need for heightened clinical suspicion in infants with unexplained abdominal symptoms.
They concluded that laparoscopic appendectomy is a feasible and effective treatment option even in very young infants when performed by experienced pediatric surgical teams, supporting the use of minimally invasive surgery as an initial operative approach.
Reference:
Lamprinou Z, Kanna E, Panayiotou D, et al. (June 04, 2026) Too Young to Suspect, Too Critical to Miss: A Rare Case of Infantile Appendicitis. Cureus 18(6): e110246. doi:10.7759/cureus.110246
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