Amyand's hernia in a neonate: A case report
A 24-day-old male neonate presented at the Department of Pediatric Surgery of The First Hospital of Jilin University in Changchun, China with right scrotal swelling for 4 days. There was no history of fever, vomiting, abdominal distension, or diarrhea. Local examination revealed a firm, tender swelling of 3.0 × 2.0 × 2.0 cm in the right inguinal region extending into the scrotum. The skin over the swelling was red and there was no fluctuation. The left scrotum and testis were normal. The neonate's total leukocyte count was increased (11.9 × 109/L). Ultrasonography detected a colon-type echo in the right inguinal canal [] measuring 30.0 × 5.0 mm. The wall of the colon-type structure measured 3.5 mm in diameter and was thickened. There were moving hyperechoes in the lumen. The right testis measured 9.9 × 5.2 mm with an anechoic region of 7.0 × 12.0 mm anterior to the right testis []. The left testis was 8.3 × 4.1 mm without any abnormalities. An ultrasonic diagnosis of right inguinal hernia and right encapsulated hydrocele of the tunica virginals was considered.\nSince the patient's presentation was not typical of a hernia, a primary clinical diagnosis of testicular tumor or epididymitis was considered. Because the neonate was considered to have epididymitis, he was started on antibiotics for 2 days. The tenderness subsided, but the right testicular swelling reduced minimally. Repeat ultrasonography showed similar features as before, including right inguinal hernia and encysted hydrocele in the right scrotum.\nThe neonate underwent surgical exploration after the second ultrasonic examination. Surgical exploration revealed swollen tunica vaginalis of the right testis. In addition, the tunica vaginalis, right testis and epididymis were found to be hyperemic and swollen with discharge of purulent material. The tunica vaginalis also contained a colon-type structure adhering to the swollen and inflamed right testis and epididymis. This colon-type structure extended into the right inguinal region and was identified as the appendix. An appendectomy was performed through the inguinal incision alone, and the right hernia sac was ligated.\nHistopathological examination of the appendix specimen revealed fibrous tissue hyperplasia in the interstitium, with acute and chronic inflammatory cell infiltration, vasodilatation, and congestion. This confirmed the diagnosis of appendicitis. The post-operative period was uneventful. An ultrasonography scan 1 week later revealed a normal scrotum and testes on both sides, and the patient was discharged from the hospital.