Infantile Internal Hernia Related to Adhesions of Appendix

Abstract

The definitive diagnosis of acute abdomen in infants is difficult. We present a unique case wherein the adhesion of the appendix to the retroperitoneum caused an internal hernia that required urgent exploration. A 44-day-old female infant with congenital myotonic dystrophy experienced sudden onset of fever and abdominal distention. Contrast-dye enema showed a tapering of her ascending colon with no visualization of the distal ileum. In the upper gastrointestinal series, the dye did not pass to the jejunum. Owing to the possibility of ileus strangulation, she underwent an emergency laparotomy, which revealed an internal hernia of the distal ileum caused by the adhesion of the appendicular tip to the retroperitoneum. There was no mesenteric defect or periappendicular abscess. Segmental resection of the ischemic ileum and appendectomy were performed, and the patient was successfully treated. Adhesion of the appendix was totally unexpected. In early infancy, even though the exact diagnosis of the pathology is not defined, urgent laparotomy is necessary to save the patient.