Perforated Appendix in Amyand Inguinal Hernia in a Neonate Presenting as Obstructed Oblique Inguinal Hernia: A Case Report and Review of Literature

Abstract

An Amyand hernia is defined as when the appendix is trapped within the sac of an inguinal hernia through a patent vaginal process. It was first described by Claudius Amyand, in 1735 during an appendectomy of a perforated appendix inside a hernial sac of an 11-year old child. Amyand hernia rare, constituting less than 1% of inguinal hernias. Amyand hernia is 3 times more likely to be diagnosed in children compared to adults due to the patency of vaginal process. Appendicitis or its perforation in Amyand hernia, complicate 0.1% of cases. Other variants include the presence of ileum, caecum or both in addition to the appendix. Isolated acute appendicitis in neonates is extremely rare, with a high mortality rate, and higher among those within Amyand hernia up to 30%. Perforated appendix in Amyand hernia is difficult to diagnose, as its clinical picture is not specific. We report a neonate 26 days old with perforated appendix in an Amyand inguinal hernia who presented by a picture of obstructed oblique inguinal hernia.He underwent emergency open inguinal exploration, herniotomy and appendicectomy. Despite the high mortality rate of Amyand hernia due to be peritoneal spread of sepsis, the boy survived complication free. Perforated appendix in Amyand hernia is exceptionally rare, and can present in the early neonatal period, its diagnosis and outcome rely on high index of suspicion and prompt surgical intervention.