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Advocating for Routine Post-natal Surveillance and Urgent Neonatal Inguinal Hernia Repair
Shreyas Dudhani1, Sourav Jana, Ramjeewan Singh
1Department of Pediatric Surgery, AIIMS, Patna, Bihar, India.
Insights
Entero-scrotal fistula is a rare complication of neonatal inguinal hernias. This case highlights the urgency of early surgical intervention in neonates with hernias to prevent severe outcomes.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Gastroenterology
Background:
- Inguinal hernias are common in neonates, with incarceration and strangulation risks in the first six months.
- Entero-scrotal fistula, a rare complication, involves herniated bowel content fistulating through the scrotal skin.
- Prompt diagnosis and management are crucial due to potential for rapid deterioration.
Approach:
- A case of entero-scrotal fistula in a 27-day-old neonate presenting with fecal discharge from the scrotum.
- Surgical management involved a staged repair: initial divided ileostomy and scrotal debridement, followed by elective ileo-ascending anastomosis.
- This approach addresses the immediate complication while planning for definitive reconstruction.
Key Points:
- The case demonstrates a rare presentation of neonatal inguinal hernia with entero-scrotal fistula.
- Early surgical intervention for neonatal hernias is advocated to prevent complications like strangulation and fistulation.
- Resource limitations and inadequate postnatal surveillance can exacerbate risks in certain settings.
Conclusions:
- Entero-scrotal fistula in neonates requires urgent surgical attention.
- Staged surgical repair can be effective in managing complex neonatal hernias with fistulation.
- Advocating for early surgical consultation and intervention in all neonatal hernias is essential.
Abstract:
Inguinal hernias are more common in preterm and neonates and incidence of incarceration are reported to be more in the first 6 months of life. Strangulation follows incarceration and various incarcerated and strangulated contents having been reported in the sac. The fistulation of the herniated content through the scrotal skin is quite rare with only a few reported cases. We present the case of entero-scrotal fistula in a neonate managed with staged repair along with a brief review of the literature. A 27-days-old, full-term male presented with faecal discharge from the right scrotum. He had no tell-tale signs of obstructed hernia. A faecal fistulous opening was located in the right hemi-scrotum. The terminal ileum was seen as the content with an antimesenteric perforation, divided ileostomy and scrotal debridement was done and later ileo-ascending anastomosis was performed electively. Neonatal hernias should be considered an urgency and we advocate early surgery. The resource-limited setting and poor post-natal surveillance may have added to the worries. In our case, swelling and fistulation occurred in a very brief period of 36 h. We managed the child with a diversion stoma followed by ileo-ascending anastomosis later.
