Neonatal appendicitis with rectal bleeding: an unusual presentation.

Background: Neonatal appendicitis is an exceptionally rare condition with a high risk of delayed diagnosis and perforation. Its nonspecific clinical presentation may mimic other causes of acute abdomen and gastrointestinal bleeding in newborns, particularly necrotizing enterocolitis.

Case presentation: A 36-week, 2500-g male neonate developed abdominal distension, irritability, decreased oral intake, and bright red rectal bleeding on the second day of life. Abdominal radiography demonstrated multiple air-fluid levels, while ultrasonography revealed dilated bowel loops and free intraperitoneal fluid. Exploratory laparotomy revealed a hyperaemic, oedematous, and indurated appendix with localized inflammatory changes, without perforation or gangrenous changes. Appendectomy was performed, and histopathological examination confirmed acute appendicitis with transmural inflammation and fibrinous exudates, without necrosis or histopathological findings suggestive of necrotizing enterocolitis. The patient recovered uneventfully, and no further rectal bleeding was observed after appendectomy.

Conclusion: Neonatal appendicitis should be considered in the differential diagnosis of newborns presenting with hematochezia, particularly when rectal bleeding is accompanied by abdominal distension and signs of intestinal obstruction or ileus. Although the condition is rare and its clinical presentation is nonspecific, recognition of atypical presentations may facilitate timely surgical evaluation and treatment.