Strangulated Amyand’s hernia containing gangrenous appendix and cecum in a preterm neonate

TL;DR

A preterm baby had a rare type of hernia with a gangrenous appendix and cecum, requiring urgent surgery to prevent serious complications.

Contribution

This case highlights the importance of rapid diagnosis and surgery for a rare neonatal hernia to prevent severe outcomes.

Findings

A preterm neonate presented with a strangulated Amyand’s hernia containing gangrenous appendix and cecum.

Urgent surgery resolved the condition without complications, preserving testicular viability.

The case underscores the need for immediate ultrasound and surgical intervention in such rare neonatal hernias.

Abstract

Amyand’s hernia defined as the presence of the appendix within an inguinal hernia sac, is rare in neonates and can deteriorate quickly. We report a preterm male twin (33 + 6 weeks; 1460 g) presenting at 1 month with 24 hours of progressive right inguinoscrotal swelling, erythema, irritability, and absent stooling. Exam showed a tender, nonreducible, non-transilluminating mass with abdominal distension. X-ray revealed dilated bowel loops; ultrasound suggested an indirect right inguinal hernia containing an inflamed appendix. Urgent inguinal exploration found incarcerated viable cecum and a gangrenous appendix. Appendectomy through the same incision with high sac ligation and posterior wall repair (no mesh) was performed. Recovery was uneventful: feeds resumed, weight gain continued, and the ipsilateral testis remained viable. This Type 2 Amyand’s hernia shows localized vascular compromise of the appendix in preterm infants and supports immediate targeted ultrasound and prompt surgery to avert perforation, sepsis, and gonadal injury.

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