Neonatal perforated appendicitis in incarcerated inguinal hernia in the differential diagnosis of testis torsion

Abstract

Appendicitis in newborns is uncommon and difficult to diagnose. Reports on neonatal appendicitis subsequent to inguinal hernia incarceration are exceptionally rare. We present the case of a 26-day-old infant with perforated appendicitis due to incarceration of a right inguinal hernia, mimicking right testicular torsion.

Three Different Presentations of Amyand’s Hernia in Premature Infants

“…The differential diagnosis in this age group includes incarcerated inguinal hernia with bowel and torsion of an undescended testis. 6 Ultrasound and computed tomography have been used in the preoperative diagnosis. Due to the risk associated with exposure to ionizing radiation, ultrasound has been reported more often in children.…”

Apendicitis aguda perforada con diagnóstico prequirúrgico y hernia inguinal bilateral en recién nacido de pretérmino

“…Otros desafíos en el diagnóstico radiológico es sospechar la inflamación apendicular cuando se encuentra dentro del conducto inguinal (Hernia de Amyand) 20 , así como otras complicaciones, como es el caso de la apendicitis en el contexto de una enterocolitis necrotizante 5,6,21 , hernias atascadas bajo las cuales subyace una apendicitis complicada 10 , cuadros que se presentan como torsión testicular u ovárica, en las cuales hay un apéndice inflamado y perforado 22,23 . Hacer el diagnóstico en forma oportuna permite orientar de mejor manera las estrategias quirúrgicas.…”

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

“…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] .…”

“…The patient underwent laparoscopy, which revealed dilated bowel loops and an inflammatory mass in the right iliac fossa, inflamed and necrotic appendix. Conversion to laparotomy was made and the appendectomy was performed The postoperative course was normal without complications and the patient was discharged on the third day Erginel et al [10] 1 patient/ 24 days of birth The neonate developed scrotal swelling at 24 days of life, two days later he was brought to the clinic, physical examination revealed hard right testicle, local heat and erythema Inguino-scrotal ultrasound suggested testicular ischemia and an edematous right testicle, so incarcerated inguinal hernia was suspected. Emergency surgery was performed and a right transverse incision was made, finding thickened spermatic cord and incarcerated perforated appendix, in addition to purulent fluid The patient was discharged home on the fifth day without complications Cigsar et al [11] 4498 patients.…”