Incarcerated Amyand's hernia Personal experience and literature review
Insights
Amyand's hernia, the presence of the vermiform appendix in an inguinal hernia, was observed in two infants. Surgeons successfully performed inguinal herniotomy without appendectomy, demonstrating a safe approach for this rare condition.
Area of Science:
- Pediatric Surgery
- Surgical Anatomy
Background:
- Amyand's hernia is defined as the incidental finding of the vermiform appendix within an inguinal hernia sac.
- This condition is rare, particularly in infants, and presents diagnostic and surgical challenges.
Purpose of the Study:
- To present two cases of Amyand's hernia in infants.
- To evaluate the surgical management and outcomes of non-inflamed appendix within an inguinal hernia.
Main Methods:
- Two infants, aged 30 days and 4 months, presented with non-reducible inguinal masses.
- Surgical exploration under general anesthesia revealed the vermiform appendix within the inguinal hernia sac.
- Herniotomy was performed using the Mugnai-Ferrari technique, with successful reduction of the appendix.
Main Results:
- The vermiform appendix was identified in the inguinal hernia sac in both pediatric patients.
- No signs of inflammation were noted in the appendices.
- Both patients underwent successful inguinal herniotomy and appendix reduction without complications.
- Postoperative recovery was uneventful, with early discharge.
Conclusions:
- In cases of non-inflamed appendix within an inguinal hernia (Amyand's hernia), appendectomy is not indicated in infants.
- Preserving the appendix avoids unnecessary surgical morbidity and mortality in pediatric patients.
- Standard herniotomy with appendix reduction is the recommended surgical approach.
Abstract:
The finding of vermiform appendix in an inguinal hernia is called Amyand's hernia. Two cases of a 30 days and 4 months old children respectively are presented; they had been visited a month earlier and scheduled for inguinal herniotomy in elective surgery. On admission both the patients presented a non-reducible mass in the right inguinal region. Surgical exploration was performed under general anaesthesia. Inguinal canal is opened through transverse lower abdominal skin incision. We palpated a tubular swelling, of tense-elastic consistence through swollen cremaster muscle and hernial sac. Separating cremaster muscle, we opened swollen hernia sac and we found the vermiform appendix, not inflamed. We easily reduced the appendix into the peritoneum cavity, and then we performed the herniotomy according to the Mugnai-Ferrari technique. No post-operative morbidity was reported. The patients was discharged in the first postoperative. We did not have any doubt about avoiding appendectomy in both cases presented; in fact such an intervention, especially in so young patients, had no pathophysiological justification, while it increases the postoperative mortality rate.
Key Words:
Amyand's hernia, Appendectomy, Inguinal hernia.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
01:30Aneurysm I: Introduction
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations: