Amyand's hernia in infant: a rare entity

Left-sided amyand hernia: report of two cases with review of literature

The presence of the vermiform appendix in an inguinal hernial sac is called “Amyand” Hernia, which is a rare condition especially in children. The authors are reporting two cases of left-sided Amyand hernia in infants presented with symptoms and signs of obstructed inguinal hernia. Emergency appendectomy and herniotomy were performed. The patients were followed up for 4 to 6 months without complications. The case histories are presented, and the conditions discussed with review of the literature.

Amyand's hernia: a review

Amyand’s hernia is defined as when the appendix is trapped within an inguinal hernia. While the incidence of this type of hernia is rare, the appendix may become incarcerated within Amyand’s hernia and lead to further complications such as strangulation and perforation. Incarceration of the appendix most commonly occurs within inguinal and femoral hernias, but may arise to a lesser extent in incisional and umbilical hernias. Incarcerated appendix has been reported in a variety of ventral abdominal and inguinal locations, yet its indistinct clinical presentation represents a diagnostic challenge. This paper reviews the literature on incarceration of the appendix within inguinal hernias and discusses current approaches to diagnosis and treatment of Amyand’s hernia and complications that may arise from incarceration of the appendix within the hernia.

Laparoscope-assisted diagnosis and treatment for Amyand's hernia in children-report of six cases

Laparoscope-assisted diagnosis and treatment of Amyand's hernia in children are rarely reported in literature. We report our preliminary experiences to emphasize the advantages and feasibility of this procedure in six cases. Laparoscope-assisted diagnosis and treatment of Amyand's hernias in six children from October 2010 to February 2012 were performed. A retrospective analysis of clinical data of these patients was performed. The mean age of the six patients was 234 days (ranging from 40 days to 13 months). Four cases were operated with laparoscope-assisted method urgently as incarcerated hernia. To the two cases with normal appendix, only herniorrhaphy was performed. Average follow-up was 14 months (9-24 months), with no wound infection and no recurrent hernias. In conclusion, diagnosis of Amyand's hernia before operation is difficult, and laparoscopic method is safe and effective in these cases with good outcomes, and worth introduced.

Left inguinal appendix in an HIV patient: A case report and review of literature

INTRODUCTION

The presence of the appendix in an inguinal hernia sac is rare, with an estimated incidence of 0.51-1% of all inguinal hernias. An inguinal appendix is most commonly referred to as Amyand's hernia.

PRESENTATION OF CASE

A 59-year-old HIV positive male presented to our center with a left painful inguinal mass. The preoperative diagnosis was a left inguinal hernia. Intraoperatively, the sac was found to contain a non inflamed appendix; the appendix was reduced back to the peritoneal cavity and the patient underwent a tension free prosthetic left inguinal hernia repair.

DISCUSSION

Most cases of inguinal appendices are right-sided and are diagnosed intraoperatively; left-sided cases as we encountered are rare and most likely the result of cecal mobility. Preoperative diagnosis of the entity is difficult and most cases are diagnosed intraoperatively. A CT scan is not necessary unless other pressing differentials need to be ruled out. Most authors agree that if the appendix is not inflamed, appendectomy, concurrently with herniorrhaphy, should not be performed to avoid perioperative septic complications.

CONCLUSION

Surgical management of inguinal appendices carries a risk of septic complications. This is especially pertinent to our case, considering the immunocompromised status of our patient. The decisions in the operating room were geared toward limiting septic potential.