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Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention; however, it is extremely rare in infants. Its diagnosis and treatment are challenging due to nonspecific clinical signs and symptoms. As a result, delayed or missed diagnosis is common in young children and is associated with an increased risk of perforation and peritonitis. We reported a case of a 4-month-old healthy male child. The patient presented with abdominal distention and fever. After ruling out other possible causes, he was diagnosed with acute appendicitis, which was confirmed by a CT scan. A gangrenous appendix, dilated bowel loops, and free fluid in the abdomen were discovered during surgery. An appendectomy was performed. The appendix in infants has an average length of 4.5 cm compared with 9.5 cm in adults. Infantile appendicitis is considered rare but cases have been documented also in neonates, misdiagnosis rates are high due to rarity in this age group in addition to nonspecific signs and symptoms, which led to a high perforation rate. Ultrasonography can diagnose appendicitis in children with a sensitivity and specificity of 90%-95% without subjecting the child to radiation. A physician should always keep the diagnosis of appendicitis in mind in the infant age group, even though it is rare, as a delay in diagnosis and treatment has been associated with an increased risk of complications including appendicular perforation and peritonitis.

The objective of this work was to quantify the effect of atmospheric pressure changes on gas transmission through microperforations, in order to understand the role of fluctuations in the atmospheric pressure on the headspace composition of microperforated modified atmosphere packages. A 3D numerical model that considers the spatial-time and pressure dependence of the gas composition was adapted to simulate the gas exchange through microperforations at different fixed pressures and at variable pressure due to atmospheric pressure fluctuations (such as those caused by atmospheric tides or by the development of high and low-pressure systems) or to changes in altitude during land or air transport. The model results were successfully verified with experimental data recorded in an experimental system built to measure the CO 2 exchange through microperforations affected by pressure changes due to weather conditions (the root mean squared error of the CO 2 composition was 0.01%). The results reveal the importance of contemplating the convective flow generated by a change in pressure outside the package. In the simulated routes, the difference in CO 2 concentration between considering the pressure-driven flow and neglecting it is one order of magnitude in a 10-h land transport through a medium mountain route, for a 1250 mL container with a single microperforation of 7420.6 μm2 area and initial CO 2 concentrations on both sides of the hole of 0.05% and 20.95%. The air transport simulations showed that it is not enough to consider the difference in altitude between the cities of origin and destination, but rather all the pressure fluctuations along the route must be included in the model. • Convective flow in a microperforated package induced by external pressure changes. • Model for accurately predicting pressure-driven flow in a package. • Flow through a microperforation influenced by atmospheric pressure fluctuations. • How the local altitude can impact the flow through a microperforated package. • Gas exchange during the land and air transport of a microperforated package. [ABSTRACT FROM AUTHOR]

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention; however, it is extremely rare in infants. Its diagnosis and treatment are challenging due to nonspecific clinical signs and symptoms. As a result, delayed or missed diagnosis is common in young children and is associated with an increased risk of perforation and peritonitis. We reported a case of a 4-month-old healthy male child. The patient presented with abdominal distention and fever. After ruling out other possible causes, he was diagnosed with acute appendicitis, which was confirmed by a CT scan. A gangrenous appendix, dilated bowel loops, and free fluid in the abdomen were discovered during surgery. An appendectomy was performed. The appendix in infants has an average length of 4.5 cm compared with 9.5 cm in adults. Infantile appendicitis is considered rare but cases have been documented also in neonates, misdiagnosis rates are high due to rarity in this age group in addition to nonspecific signs and symptoms, which led to a high perforation rate. Ultrasonography can diagnose appendicitis in children with a sensitivity and specificity of 90%-95% without subjecting the child to radiation. A physician should always keep the diagnosis of appendicitis in mind in the infant age group, even though it is rare, as a delay in diagnosis and treatment has been associated with an increased risk of complications including appendicular perforation and peritonitis., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)