The youngest ever reported foreign body appendicitis in a 9‑month‑old infant secondary to wheat seed ingestion: a case report from Ethiopia

Abstract

Importance and introduction: Appendicitis of infants less than 1 year of age is unusual and has a propensity to perforate. Foreign body-induced appendicitis is even less common, especially in early infancy and is challenging to diagnose. Case presentation: A male infant, 9 months old, was presented with three days of vomiting, irritability and poor feeding. Physical examination revealed tachycardia, tachypnea, fever (38.9 °C) and right lower quadrant tenderness (both direct and rebound). Ultrasound showed a dilated retrocecal appendix with distal perforation and an echogenic focus within the lumen with posterior acoustic shadowing suggestive of a foreign body. Emergency open appendectomy revealed a wheat seed at the site of the perforation with purulent peritonitis. The infant was given perioperative antibiotics and made an uneventful recovery. Clinical discussion: Foreign body appendicitis in infants is very rare, with most cases seen in the older child. This case describes the diagnostic role of ultrasound in detecting an intraluminal foreign body and the necessity of early surgical intervention. It also highlights the importance of considering unwitnessed ingestion during the weaning period. Conclusion: Foreign body appendicitis may arise in early infancy and can have a fulminant progression to perforation. Hastiness in diagnoses with ultrasound and prompt surgical intervention is critical to ensure favorable outcomes.