Amyand's hernia in the children: A single center experience
Accepted 29 September 2009. published online 12 November 2009.
Background
The presence of a vermiform appendix in an inguinal hernial sac is termed Amyand's hernia. It may present as a tender inguinal or inguinoscrotal swelling, and it is often misdiagnosed as an incarcerated or strangulated hernia.
Methods
Between 1998 and 2006, we have managed 564 patients with acute appendicitis, 1,090 patients with inguinal hernia, 33 patients with incarcerated inguinal hernia, and 12 patients with Amyand's hernia on our pediatric surgery service. A retrospective analysis of clinical data of these patients with Amyand's hernia was performed.
Results
All patients with Amyand's hernia were boys with a median age of 40 days (range, 15 days–14 months). One patient's condition was diagnosed pre-operatively. All of them, therefore, underwent emergency operation with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 2 normal appendices, 6 inflamed appendices, and 4 appendices with external signs of serosal inflamation of uncertain significaince in the inguinal hernial sac. Two patients with a normal appendix had hernia repair without an appendectomy. The other 10 patients with an abnormal appendix underwent an emergency open appendectomy with repair of the inguinal hernia. None of the patients developed recurrent hernia. The median postoperative follow-up period was 2.5 years.
Conclusion
In pediatric patients with Amyand's hernia, the inflammatory status of the appendix can be used to determine the type of hernia repair and the operative approach. Incidental appendectomy in the case of a normal appendix is not favored by us. Treatment includes appendectomy (via the hernia sac) and hernia repair in children with an inflamed appendix.
aDepartment of Pediatric Surgery, Medical School of Cumhuriyet University, Sivas, Turkey
bDepartment of Pathology, Medical School of Cumhuriyet University, Sivas, Turkey
cDepartment of Radiology, Medical School of Cumhuriyet University, Sivas, Turkey
Reprint requests: Levent Cankorkmaz, MD, Department of Pediatric Surgery, Cumhuriyet University, Kamp's, 58140 Sivas, Turkey.
ABSTRACT