Clinical features of Amyand′s hernia in neonates: cases report and literature review

Objective To investigate the characteristics of Amyand′s hernia (AH) in neonates in order to decrease the complications and to improve the prognosis. Methods Data about neonates with AH in Department of Neonatal Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology, were collected from January 2010 to February 2017, and the AH cases published from 1997 to 2017 in PubMed and Wanfang Data were also reviewed. Results Twenty-two cases were collected, including 8 cases treated in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology, and 14 cases from literature reports.In this group, 4 cases underwent traditional operation and 4 cases underwent laparoscopy, respectively.All the patients underwent appendix resection and the ligation of the hernia sac.Among the 4 cases who underwent laparoscopic operation, contra-lateral hernia was found in 2 cases and pyocelia in 1 case.However, the appendix had a solid adhesion with the inguinal canal in those 4 cases and it was difficult to return the appendix to the cavity.Thus, the laparoscopy had to be terminated and the traditional procedure was carried out to separate the adhesion.In those 4 cases to whom the traditional operation was applied, 1 case presented inflammation in abdomen and the contra-lateral hernia after operation.According to the pathological results of appendix, in this group, there were 3 cases, 4 cases, and 1 case that presented Ⅱ, Ⅲ, Ⅳ type, respectively.In literature cases, there were 13 cases and 1 case that underwent traditional operation and laparoscopy, respectively.There were 4 cases, 9 cases, and 1 case that presented Ⅱ, Ⅲ, Ⅳ type, respectively.The complications included located peritonitis (1 case), testicular torsion (1 case) and orchitis (1 case). All cases recovered smoothly. Conclusion Most of the AH cases in neonates present appendix suppuration, gangrene or perforation.The neonatal cases with AH also present obvious local infection and they are prone to develop into pyocelia in inguinal canal and abdominal cavity.In AH cases, laparoscopy has its own advantages, which not only help to make it clear if there is the contralateral hernia, but also helps to treat the complicated pyocelia in abdominal cavity, which help to avoid the residual infection efficiently. Key words: Infant, newborn; Incarcerated hernia; Amyand′s hernia; Appendicitis; Laparoscopy