[Acute neonatal appendicitis in an inguinal hernia].
Acute neonatal appendicitis is a rare surgical emergency. Prognosis depends on early diagnosis and management.


METHODS
A three and a half-month-old premature infant needed an urgent laparotomy because of an occlusive syndrome and sepsis with an inflammatory skin reaction. The per-operative diagnosis was suppurative acute appendicitis with local peritonitis, the appendix being strangulated into the inguinal hernia.


CONCLUSIONS
Neonatal appendicitis represents 0.1% of all infantile appendicitis. Fifty percent of such cases occur in premature infants. Two clinical presentations exist, whose diagnosis is often made during surgery. The abdominal presentation (2/3 of the cases) can mimic necrotizing enterocolitis; the diagnosis is often late and evolution leads to diffuse peritonitis in the majority of the cases, while the mortality rate is higher than 50%. The intra-hernial presentation (1/3 of the cases), instead, is usually diagnosed and managed early due to the inguino-scrotal induration, while mortality rate is near zero.


CONCLUSIONS
The high frequency of inguinal hernia in premature infants should not mask the risk for intra-hernial appendicitis. Inguino-scrotal inflammation should evoke the diagnosis. Prognosis depends on early and urgent surgical management.
Guelouz
N
N
Service de réanimation néonatale, institut de puériculture et de périnatalogie, 26, boulevard Brune, 75014 Paris, France.
Rigourd
V
V
Dommergues
M A
MA
Rizkallah
J
J
Ayachi
A
A
Kieffer
F
F
Magny
J F
JF
D000208:Acute Disease; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D003937:Diagnosis, Differential; D006552:Hernia, Inguinal / Q000150:complications* / Q000601:surgery; D006801:Humans; D007223:Infant; D007249:Inflammation; D008297:Male; D010538:Peritonitis / Q000209:etiology; D011379:Prognosis; D018805:Sepsis / Q000209:etiology; D012871:Skin Diseases / Q000209:etiology