Neonatal acute appendicitis: a strangulated appendix in an incarcerated inguinal hernia

Abstract

A 4-day-old infant with acute appendicitis (AA) due to incarceration of a right inguinal hernia is presented. Although appendicitis is the most common condition requiring abdominal surgery, the reported occurrence of AA subsequent to neonatal hernia incarceration is exceptionally rare.

Neonatal appendicitis: a new look at an old zebra

“…As survival of young babies improves with better perinatal care, one would expect the frequency of appendicitis to rise along with the incidence of NEC in this population [5]. The rarity of appendicitis in the neonatal period (b0.04% reported incidence) is classically attributed to the broad orifice of the appendix ("conical," "funnel," or "fetal" anatomy), liquid diet, near-constant supine positioning, the lack of fecaliths in neonates, and the presumed relative infrequency of lymphatic hyperplasia in the periappendiceal region caused by lack of infectious stimuli [1][2][3][6][7][8]. The infrequency of this disease and resultant delay in diagnosis are largely responsible for the higher reported associated morbidity and mortality in perinatal vs other age groups [1].…”

Amyand’s hernia presenting as neonatal testicular ischaemia

“…Since this time, two further cases in all languages have been reported of neonatal appendicitis within a hernia [6,7]. The commonest presentation is that of an incarcerated inguinal hernia with the diagnosis being made during herniotomy.…”

Inflamed vermiform appendix within the sac of incarcerated left inguinal hernia

“…However, left-sided Amyand's hernia is also defined as a highly rare situation [2][3][4] and may be associated with situs inversus, intestinal malrotation or mobile cecum. [5] Amyand's hernia is also seen in neonates or children [6,7] as well as adults, and is more frequent in males. [8] When patients diagnosed as Amyand's hernia are examined retrospectively, the absence of acute abdominal symptoms is determined in most of them.…”