Left-Sided Amyand Hernia: Report of Two Cases with Review of Literature

Abstract

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.

Controversias en el tratamiento de la hernia de Amyand

“…El tratamiento se basa en la apendicectomía y en la reparación del defecto herniario. No obstante, siguen existiendo ciertas controversias sobre su manejo en determinadas situaciones [4][5][6] . A continuación se presentan dos casos clínicos.…”

Left-Sided Amyand Hernia: Case Report and Review of the Literature

“…Additionally, some cases of left-sided Amyand hernia described herein, including our case, are recurrent cases of a previous hernia that have been surgically repaired. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Presentation of Amyand hernia often resembles that of a complicated inguinal hernia, acute appendicitis, or both. Hence, clinicians should consider this a possibility when patients present with signs and symptoms that could otherwise be thought to be originating from an incarcerated, strangulated, or recurrent hernia.…”

“…Specifically, these signs and symptoms include a ten-der, nonreducible mass in the inguinal region, acute lower abdominal pain, nausea, or signs of intestinal obstruction such as failure to produce bowel movements. 4,17 Because of the unusual anatomy in patients presenting with left-sided Amyand hernia, tenderness at the McBurney point usually is absent and not a useful diagnostic tool to rule out acute appendicitis.…”

“…Nonetheless, many contend that indiscriminately performing appendectomies in all cases of left-sided Amyand hernia is useful as a prophylactic measure, as cases of future appendicitis in these patients will have atypical presentations based on the contralateral location of the appendix. 6,11,17 Others disagree, citing that prophylactic appendectomy in the case of a normal looking appendix is unnecessary and complicates an otherwise sterile surgery (clean wound classification) with the removal of an appendix containing fecal matter and gut microbiota (converted into a clean contaminated or a contaminated wound classification). 17 Additionally, it is thought that in the cases of middle-aged or geriatric patients where the chances of appendicitis are far less, the risks of detriment from prophylactic appendectomy may outweigh the benefits.…”

“…6,11,17 Others disagree, citing that prophylactic appendectomy in the case of a normal looking appendix is unnecessary and complicates an otherwise sterile surgery (clean wound classification) with the removal of an appendix containing fecal matter and gut microbiota (converted into a clean contaminated or a contaminated wound classification). 17 Additionally, it is thought that in the cases of middle-aged or geriatric patients where the chances of appendicitis are far less, the risks of detriment from prophylactic appendectomy may outweigh the benefits. In these cases, a macroscopic view of the appendix based on visual examination during the operation should guide decision making.…”