[Acute neonatal appendicitis in an inguinal hernia].

Area of Science:

• Pediatric Surgery
• Neonatal Medicine
• Surgical Emergencies

Background:

• Neonatal appendicitis is a rare but serious condition, accounting for 0.1% of all infantile appendicitis cases.
• Premature infants are disproportionately affected, representing 50% of neonatal appendicitis cases.
• The condition presents diagnostic challenges, often requiring surgical intervention for definitive diagnosis.

Observation:

• A case report details a premature infant with occlusive syndrome, sepsis, and an inflammatory skin reaction requiring emergency laparotomy.
• Intraoperative findings revealed suppurative acute appendicitis with local peritonitis, complicated by a strangulated appendix within an inguinal hernia.
• Two primary clinical presentations exist: abdominal (mimicking necrotizing enterocolitis) and intra-hernial.

Findings:

• The abdominal presentation (two-thirds of cases) is frequently diagnosed late, leading to diffuse peritonitis and a mortality rate exceeding 50%.
• The intra-hernial presentation (one-third of cases) is often diagnosed and treated early due to characteristic inguino-scrotal induration, with a near-zero mortality rate.
• Inguinal hernias in premature infants can mask appendicitis, highlighting the importance of considering this diagnosis in cases of inguino-scrotal inflammation.

Implications:

• Prompt recognition of intra-hernial appendicitis is vital, even in the presence of common inguinal hernias in premature infants.
• Suspicion of appendicitis should be raised with any inguino-scrotal inflammation in neonates.
• Timely and urgent surgical management significantly improves the prognosis for neonatal appendicitis, reducing mortality and morbidity.