Infant Appendicitis: A Case Presentation of Appendicitis in a Nine-Month-Old Infant With Respiratory Syncytial Virus (RSV) and Otitis Media and Review of Literature

TL;DR

A nine-month-old infant was diagnosed with appendicitis after being initially treated for ear infection and viral illness, highlighting the difficulty in diagnosing this condition in young children.

Contribution

This case highlights the diagnostic challenges of infant appendicitis and emphasizes the importance of considering it in young children with nonspecific symptoms.

Findings

Infant appendicitis is rare and often misdiagnosed due to nonspecific symptoms and developmental communication barriers.

Delayed diagnosis increases the risk of complications such as perforation and abscess formation.

Abdominal guarding during physical examination is a key sign providers should not overlook in young children.

Abstract

Appendicitis in children < 5 years old is uncommon and even less common in children < 1 year old. Symptoms of appendicitis can be non-specific and mimic other common pediatric diseases, causing delays in diagnosis. Without a timely diagnosis, young children with appendicitis are at risk of developing worsening disease, intra-abdominal abscess, perforation, and bacteremia.

We submit a case of a nine-month-old male infant presenting with fever, vomiting, and irritability seen the day prior and treated for otitis media, who was ultimately diagnosed with appendicitis with concomitant viral infection (respiratory syncytial virus and human rhinovirus/enterovirus) and treated with intravenous antibiotics and laparoscopic appendectomy.

This case illustrates how easy it is to misdiagnose infant appendicitis due to factors including normal developmental speech barriers, nonspecific presentations, and overlap of symptoms with many other common childhood illnesses, along with a challenging abdominal examination. Delay in diagnosis leads to increased rates of perforation and complications. Providers should trust abnormal physical examination findings, especially abdominal guarding against palpation, and keep a wide differential diagnosis in order to diagnose appendicitis in young children.

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