J Leonhardt, N Derichs, T Buhr, C Dammann, S Glüer
appendicitis, incarcerated hernia, preterm
J Leonhardt, N Derichs, T Buhr, C Dammann, S Glüer. Appendicitis in a Preterm Infant with Incarcerated Inguinal Hernia. The Internet Journal of Pediatrics and Neonatology. 2006 Volume 6 Number 2.
We report a case of appendicitis and incarcerated inguinal hernia in a preterm triplet with Enterococcus faecalis sepsis. After a course of antibiotic treatment for three days, the four week old boy presented with a distended abdomen and right groin swelling due to a suspected incarcerated hernia. Surgical examination revealed an incarcerated inflamed appendix inside an inguinal hernia.
RDS: respiratory distress syndrome, CPAP: continuous positive airway pressure, IL-8: interleukin-8, NEC: necrotizing enterocolitis.
Acute appendicitis is a rare finding in newborns and very uncommon in preterm infants (1,5). We report a case with an incarcerated appendix inside an inguinal hernia in a four week old preterm boy treated immediately for
A 27 week preterm male triplet, born via cesarean section for pathological cardiotocogram with a birth weight of 1200g, was initially ventilated for RDS for three days. After extubation, CPAP was continued for four weeks. He developed clinical signs of sepsis with an elevated IL-8 value of 266 ng/l (norm <62 ng/l), but without any gastrointestinal symptoms at 30 days after birth. Blood culture was positive for
Appendicitis in newborns is uncommon due to the wide base of the appendix (3). Strangulation within an incarcerated inguinal hernia has rarely been reported previously (2,3,4). However, in some cases, an appendicitis in this age group is associated with other major diseases, e.g. chorioamnionitis, NEC or Hirschsprung`s disease (1,5,6). The diagnosis is difficult, especially if there is no concomitant perforation of the gut. The presented preterm boy developed abdominal symptoms while receiving treatment for sepsis. We suggest that a compression of the appendix in the hernial sac led to groin swelling. However, it could be speculated that the preceding infection promoted this complication, as in the case of an appendicitis associated with chorioamnionitis (5).
In summary, while appendicitis is extremely rare in preterm infants, it should be kept in mind, because it can be life-threatening if misdiagnosed.
Johannes Leonhardt, MD Dept. of Pediatric Surgery Hannover Medical School Germany Tel.: ++49-511-532-9260 Fax. ++49-511-532-9059 E-mail: Leonhardt.Johannes@mh-hannover.de