Ref Number = PITIKA-ASPR0228
Putu Pradnyanita Mustika, Made Sukmawati, I Wayan Dharma Artana, I Made Kardana, Putu Junara Putra, Made Dharmajaya, Kadek Deddy Ariyanta
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 letargic and hypoglicaemia since one days old. This complain was followed by 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 gaster and duodenum part 3 with minimum air in the distal part of duodenum, suspected 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. Recumbene 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 neonatus 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 nonspesific 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
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
Journal Office
Mid City Hospital, 3-A Shadman II
Jail Road, Lahore ,Pakistan
Managing Editor
Dr. Intan Juliana Abd Hamid
Support & Help
Assistant Editor
Dr. Sadia Shabbir Hussain
Support & Help
Digital Content Editor
Dr. Khalid Masud