Amyand hernia: scrotal pyocele, associated with perforated vermiform appendix and complicated by testicular ischemia in neonate

Abstract

The presence of vermiform appendix in an inguinal hernia sac is known as Amyand’s hernia. This research paper examines the case of a 28-day-old Syrian male presented with a history of an infected right-sided hydrocele from the age of 14 days. Upon admission, ultrasonography was reported as a right testicular torsion. Accordingly, emergency surgical exploration was performed, and by exposing the spermatic cord fascia, 7 mL of pus was drained, revealing the cecum and perforated appendix lying beside the right testis, which showed evidence of ischemia and bluish discoloration.

Bilateral congenital inguinal hernia with right-sided Amyand's hernia in a premature twin: Case report and a summary of clinical presentations, management and outcomes in neonates and infants with Amyand's hernia

“…As reported in the literature, the average age at which surgical repair of Amyand's hernias is performed during the neonatal and infancy period ranges from 5 days after birth to 16 months [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] . The most common clinical presentation is the presence of a reducible or irreducible mass, erythema and/or inguino-scrotal edema, irritability manifested by crying and recurrent pain in older infants [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] . This condition may be associated with cryptorchidism [9] , intrauterine structural developmental disorder [12] , and the presence of fistulas [15] .…”

“…The most commonly used imaging techniques for the evaluation of hernia are ultrasonography (which can demonstrate the presence of torsion or testicular ischemia) [7] , [10] , [12] , [14] , [16] , and abdominal radiography (which demonstrates the presence of gas in the case of an incarcerated hernia) [8] , [13] , [15] , [20] . Although many cases are initially operated on laparoscopically, the finding of a necrotic appendix with inflamed loops is one of the main conversion factors for laparotomy, as well as the compromise of abdominal structures such as the intestinal loops [9] .…”

“…We excluded those articles that did not present data on clinical presentations, management and outcomes of Amyand's hernia, as well as those that did not have full text available. After the application of these criteria, 15 studies were finally included [ Table 1 ] [4] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] .…”

“… Exploratory laparotomy was performed to exclude any source of intra-abdominal sepsis, and to allow adequate surgical access to treat the possibility of a hernia. The appendix was found to be incarcerated and inflamed, and an appendectomy was performed The inguinoscrotal erythema resolved and the patient was discharged home Omran et al [7] 1 patient / 28 days of birth History of right-sided infection and edema of the spermatic cord after 14 days, admitted to the emergency room for increased swelling in the right scrotum, physical examination revealed large inguinal scrotal swelling Ultrasonography reported right testicular torsion. Exploration was performed through an incision in the lateral fold to the pubic tubercle, observing the fascia of the spermatic cord, the right testicle was removed and the pus of the spermatic cord was drained.…”

Acute appendicitis located within Amyand’s hernia—a complex case with concurrent acute cholecystitis

“…Their clinical presentation is varied, ranging from asymptomatic as in our case, through to presentation as an incarcerated inguinal hernia [ 4 ]. Uncommonly, Amyand’s hernia can mimic acute scrotal pathology such as torsion or abscess [ 5 ]. With regards to acute appendicitis occurring inside the sac, either primary appendicitis can occur or prolonged incarceration of the appendix and pressure from the abdominal wall leads to inflammation of the appendix [ 6 ].…”