title: Perforated appendicitis in a 4-month-old infant.
abstract: A 4-month-old male infant was admitted to our hospital because of poor intake and mild abdominal distention for 1 day. Fever and watery diarrhea had occurred 4 days prior to admission, but subsided 2 days later after taking oral medications. A physical examination showed an acute ill-looking baby with a soft and mildly distended abdomen. The bowel sound was hypoactive and no obvious abdominal tenderness was found. Normal leukocyte and differential counts were noted in initial laboratory examinations; however, the serum level of C reactive protein was extremely high (31.4 mg/dL). Progressive abdominal distention and bilious vomiting occurred. Serial plain films of abdomen showed ileus with a fixed gas pattern and an abdominal echo revealed intraperitoneal fluid accumulation. Under the impression of intestinal perforation, an emergency laparotomy was performed. A perforated appendicitis with turbid fluid in the peritoneal cavity was noted during surgery. A pus culture grew Pseudomonas aeruginosa which was sensitive to Ceftazidime only. Triple antibiotics consisting of Prostaphlin, Metronidazole, and Ceftazidime were administered for 2 weeks. The patient was discharged 3 weeks later without any complications. Appendicitis in infancy is a rare condition and associated with a high frequency of perforation and peritonitis. Diagnosis is often difficult because of variable and nonspecific clinical manifestations.
authors.affiliation: Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Y S
authors.initials: YS
authors.lastname: Ko
authors.forename: L H
authors.initials: LH
authors.lastname: Lin
authors.forename: C S
authors.initials: CS
authors.lastname: Huang
mesh_terms: D000900:Anti-Bacterial Agents; D001064:Appendicitis / Q000097:blood / Q000150:complications* / Q000382:microbiology; D002097:C-Reactive Protein / Q000032:analysis; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein