WOFAPS 2025 8th World Congress of Pediatric Surgery

Betül Beyza Özbal ¹, Mustafa Azizoğlu ², İbrahim Baytar ¹, EMİR ZHANYBEKOVICH ZHANYBEKOV ¹, Fatma Saraç ¹, Birgül Karaaslan ¹, Tuba Erdem Şit ¹

¹ ISTANBUL BASAKSEHİR CAM VE SAKURA CİTY HOSPİTAL PEDİATRİC SURGERY
² 1 Esenyurt State Hospital, Pediatric Surgery, Istanbul. 2 Istinye University, Department of Stem Cell and Tissue Engineering, Istanbul. 3 Pediatric Surgery Stem Cell Application Study Group (PESSCA), Istanbul, Turkey

Introduction

We aimed to present a rare case of strangulated Amyand hernia with cecal perforation, caused by accumulated sunflower seed shells, resulting in peritoneal and scrotal contamination, intestinal ischemia, and sepsis, requiring urgent surgical resection, anastomosis, and intensive postoperative care due to the severity of complications.

Case presentation

A 1-year-old-male patient was admitted to the emergency department with a history of bilateral scrotal swelling for the last month and recent onset of vomiting. During the initial examination, the scrotum had severe hyperemia and edema. Laboratory findings were WBC:14,000/µL, CRP:308 mg/L, Procalcitonin:100 ng/mL. Scrotal ultrasound revealed bilateral septated fluid collections up to 2 cm. An abdominal X-ray and CT revealed air-fluid levels and herniated bowel loops into the scrotum. Suspecting a strangulated inguinal hernia, exploration was to be carried out. Appendix and perforated cecum herniated into the scrotum (Amyand hernia) and were observed with a perforation site. Numerous shelled sunflower seeds had spread from the perforated cecum into the peritoneal cavity and scrotum. The seeds and purulent contents were aspirated. The terminal ileum, cecum, and appendix were highly ischemic with perforation and necrosis in a few places. Approximately 5 cm of terminal ileum with the ileocecal valve and cecum were resected, and an anastomosis between the terminal ileum and the ascending colon was performed. The inguinal ring was closed. A drain was placed in the rectovesical space, and a penrose drain was inserted through the inguinal incision. Due to the patient's septic condition, he was closely monitored in the intensive care unit for approximately 10 days. The patient was discharged on postoperative day 15.

Conclusion

This rare case underscores the importance of considering Amyand hernia in pediatric patients with scrotal swelling, as delayed diagnosis may result in serious complications requiring extensive surgical intervention and intensive care.