Amyand's Hernia in a 6-Week-Old Infant: A Delayed Diagnosis

Appendicitis and its associated mortality and morbidity in infants up to 3 months of age: A systematic review

Background and Aims

Although appendicitis is rare in young infants, the reported mortality is high. Primary aim of this systematic review was to provide updated insights in the mortality and morbidity (postoperative complications, Clavien-Dindo grades I-IV) of appendicitis in infants ≤3 months of age. Secondary aims comprised the evaluation of patient characteristics, diagnostic work-up, treatment strategies, comorbidity, and factors associated with poor outcome.

Methods

This systematic review was reported according to the PRISMA statement with a search performed in Pubmed, Embase and Web of Science (up to September 5th 2022). Original articles (published in English ≥1980) reporting on infants ≤3 months of age with appendicitis were included. Both patients with abdominal appendicitis and herniated appendicitis (such as Amyand's hernia) were considered. Data were provided descriptively.

Results

In total, 131 articles were included encompassing 242 cases after identification of 4294 records. Overall, 184 (76%) of the 242 patients had abdominal and 58 (24%) had herniated appendicitis. Two-hundred (83%) of the patients were newborns (≤28 days) and 42 (17%) were infants between 29 days and ≤3 months of age. Either immediate, or after initial conservative treatment, 236 (98%) patients underwent surgical treatment. Some 168 (69%) patients had perforated appendicitis. Mortality was reported in 20 (8%) patients and morbidity in an additional 18 (8%). All fatal cases had abdominal appendicitis and fatal outcome was relatively more often reported in newborns, term patients, patients with relevant comorbidity, nonperforated appendicitis and those presented from home.

Conclusion

Mortality was reported in 20 (8%) infants ≤3 months of age and additional morbidity in 18 (8%). All patients with fatal outcome had abdominal appendicitis. Several patient characteristics were relatively more often reported in infants with poor outcome and adequate monitoring, early recognition and prompt treatment may favour the outcome.

The Appendix Is Not Always Alone in Amyand's Hernia

An inguinal hernia is one of the most common surgical conditions accounting for both elective as well as acute admissions. Amyand's hernia is a rare entity of inguinal hernia, which represents a very small percentage of all inguinal hernias. While in most cases it is an incidental finding encountered during routine repair of an inguinal hernia, in other cases, it might be the reason for acute presentation. We are presenting a case of a six-week-old male who was found intraoperatively to have not only the appendix but also the caecum in the hernia sac. We believe that a preoperative groin ultrasound scan would aid clinical diagnosis and facilitate surgical planning in these cases.

Neonatal Appendicitis and Incarcerated Inguinal Hernia: Case Report and Review of the Literature

Neonatal appendicitis carries a high mortality rate. We describe a peculiar case presented after an incarcerated hernia manually reduced in a 4-week-old male neonate with ipsilateral undescended testis. Laparoscopy allowed a prompt recognition of an unexpected intra-abdominal life-threatening condition. Pathogenesis, treatment, and outcome are discussed on the light of a comprehensive literature review.

Timely recognition of Amyand's hernia with appendicitis in infants

BACKGROUND

Amyand's hernia with acute appendicitis is rare in infants and is mostly delayed in diagnosis and treatment, resulting in a high morbidity.

METHODS

We presented two cases of infantile Amyand's hernia with acute appendicitis.

RESULTS

Early surgical interventions were performed and both patients recovered without complication.

CONCLUSION

A practical strategy for this entity is to be aware of the rare disease and to perform early surgical exploration for suspected cases.

Left-sided amyand hernia: report of two cases with review of literature

The presence of the vermiform appendix in an inguinal hernial sac is called “Amyand” Hernia, which is a rare condition especially in children. The authors are reporting two cases of left-sided Amyand hernia in infants presented with symptoms and signs of obstructed inguinal hernia. Emergency appendectomy and herniotomy were performed. The patients were followed up for 4 to 6 months without complications. The case histories are presented, and the conditions discussed with review of the literature.