Abstract: Objective:To investigate the risk factors for appendicitis caused by incarcerated inguinal hernia in infants.
Methods:The retrospective case-control study was conducted. The clinicopathological data of 371 infants with incarcerated inguinal hernia who were admitted to Wuhan Children′s Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2010 and December 2018 were collected. There were 256 males and 115 females, aged from 0 to 90 days, with an average age of 47 days. Observation indicators: (1) situations of incarcerated hernia; (2) surgical and postoperative recovery; (3) postoperative pathological examination; (4) analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants. Measurement data with skewed distribution were described as M (range). Count data were expressed as absolute numbers. Univariate analysis was performed using the chisquare test. Multivariate analysis was performed using the Logistic regression model.
Results:(1) Situations of incarcerated hernia: of the 371 infants, 264 had bowel incarceration, 102 had ovarian incarceration, 2 had both bilateral ovarian and bowel incarceration, 1 had bilateral ovarian and womb incarcerated into one side, and 2 had Meckel′s diverticulums incarceration. Among the 264 infants with bowel incarceration, 29 had Amyand′s hernia, including 18 of ileocecal incarceration (3 with appendicitis) and 11 of pure appendix incarceration (10 with appendicitis). (2) Surgical and postoperative recovery: of the 29 infants with Amyand′s hernia, 10 underwent laparoscopic hernia sac high ligation and 19 underwent inguinal explorations, relaxation of hernia ring and then hernia sac high ligation. One infant undergoing laparoscopic hernia sac high ligation had pure appendix incarceration. It showed that chorda at the blind end of appendix was connected with the bottom of hernia sac intraoperatively. There was no obvious inflammation in the appendix. Chorda was released, and the appendix was reset into the abdominal cavity. One infant was resected appendix because of its inflammation after ileocecal reduction. Twelve infants undergoing inguinal explorations, relaxation of hernia ring and then hernia sac high ligation had appendicitis (2 of ileocecal incarceration and 10 of pure appendix incarceration), and received appendectomy and hernia sac high ligation. One infant of ileocecal incarceration had postoperative intestinal adhesion, and was found local adhesion and stenosis after abdominal reexploration. The infant underwent ileocecoectomy followed by ileumascending colon anastomosis. All infants recovered well after operation. (3) Postoperative pathological examination: 13 of 29 Amyand′s hernia infants had appendictis, 4 of which were confirmed as appendix suppuration by pathological examination, 2 were appendix suppuration and perforation, and 2 were gangrene. (4) Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia. Results of univariate analysis showed that age, local swelling and erythema of the hemiscrotum, intestinal obstruction, and incarceration location were related factors for the appendicitis caused by incarcerated inguinal hernia (x²=10.598, 15.603, 9.732, 3.866, P<0.05). Multivariate analysis showed that age less than 28 days, local swelling and erythema of the hemiscrotum, no obvious obstruction were the independant risk factors for appendicitis caused by incarcerated inguinal hernia (odds ratio: 4.537, 35.506, 34.565, 95% confidence interval: 1.014-20.296, 6.447-195.552, 6.370-187.546, P<0.05).
Conclusion:Age less than 28 days, local swelling and erythema of the hemiscrotum, and no obvious obstruction are independent risk factors for appendicitis caused by incarcerated inguinal hernia.