# 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.

## Key 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.