Preterm with appendicular abscess and subcapsular liver haematoma: an unreported association

Abstract

Neonatal appendicitis is a rare yet serious condition. Known reported associations are Hirschsprung’s disease, necrotising enterocolitis (NEC) and cystic fibrosis. The occurrence of subcapsular liver haematoma in preterm neonates can be life threatening. We present an unreported association of these two serious conditions in a preterm infant with appendicular abscess and subcapsular liver haematoma. She presented with sepsis, enlarged liver and tender right iliac fossa mass. Laparotomy was performed for possible complicated NEC. Intraoperatively, there was an appendicular abscess with a small subcapsular liver haematoma and no evidence of NEC. Appendectomy and peritoneal toilet were performed. She had a stormy postoperative period due to sepsis, thrombocytopaenia and expansion of her liver haematoma. The pathology of her appendix was in keeping with appendicitis, with no evidence of NEC. Her liver haematoma gradually resolved. Suction rectal biopsy showed normal ganglia. She was discharged after 7 weeks and remained well since then.

Keywords: hematoma, liver, neonatal appendicitis, preterm, subcapsular