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Klyuev S, Azizoğlu M. Challenges in strategies for Amyand hernia in children: literature review with clinical illustrations. ANNALS OF PEDIATRIC SURGERY 2023; 19:36. [DOI: 10.1186/s43159-023-00267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/05/2023] [Indexed: 05/13/2024] Open
Abstract
Abstract
Introduction
Amyand hernia (AH) is a rare disease, so there are no standard strategies and there are many different aspects at each stage of its management. Based on our own experience, we encountered these differences even in a small number of cases and therefore sought to review the literature to highlight the diversity of approaches to this pathology. This review of the literature was not intended to describe the statistical findings found in the clinical case series, but rather to highlight the clinical and surgical difficulties of AH in children. Nevertheless, we conducted an introductory statistical study based on data from PubMed and Google Scholar to understand the global prevalence of AH.
Materials and methods
The search for the key terms Amyand hernia, Amyand’s hernia, and “children” between 2003 and 2023 resulted in 52 PubMed and 548 Google Scholar articles.
Results
After the exclusion of irrelevant studies, 101 articles were found. A total of 83 case reports describing 182 pediatric patients were used to understand the demographic distribution of this pathology. Given the impossibility of further comprehensive statistical analysis (due to heterogeneous data), a narrative design was used to describe the remaining aspects of AH management. Finally, three clinical cases demonstrated the mentioned aspects.
Discussion
As a result of the search, conclusions were drawn about the main difficulties in the management of AH in children, which were discussed.
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Yagnik VD, Chauhan D, Garg P, Dawka S, Yagnik B, Shah D. Left-sided Amyand hernia: a rare presentation. ANZ J Surg 2022; 92:2692-2693. [PMID: 35122375 DOI: 10.1111/ans.17532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Vipul D Yagnik
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, India
| | - Deepak Chauhan
- Department of Surgery, Swami Dayanand Hospital, Delhi, India
| | - Pankaj Garg
- Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
| | - Bhargav Yagnik
- Department of Pathology, Accurex Diagnostic Laboratory, Patan, India
| | - Dhaval Shah
- Department of Radiology, Sanskar X-ray and Sonography Clinic, Patan, India
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Papaconstantinou D, Garoufalia Z, Kykalos S, Nastos C, Tsapralis D, Ioannidis O, Michalinos A, Chatzimavroudis G, Schizas D. Implications of the presence of the vermiform appendix inside an inguinal hernia (Amyand's hernia): a systematic review of the literature. Hernia 2020; 24:951-959. [PMID: 32451789 DOI: 10.1007/s10029-020-02215-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/06/2020] [Indexed: 12/08/2022]
Abstract
PURPOSE To identify and sum all available evidence pertaining to the management of Amyand's hernia (AH). METHODS A systematic search of the MedLine, Scopus, and Google Scholar databases was performed for studies published until January 2020. RESULTS In total, 111 studies incorporating 161 patients were identified, 96 (86.4%) being case reports, 11 (9.9%) case series, and 4 (3.7%) retrospective patient cohorts. Mean patient age was 58.5 ± 19.6 years with 136 (83.9%) being males and 25 (16.1%) females. Furthermore, 149 (92.5%) cases were right-sided hernias while 12 (7.5%) cases were left-sided. Overall, 62.3% of patients presented emergently and 77.3% of patients' cohort were eventually diagnosed with incarcerated AH. Preoperative diagnosis of AH was established in 23.1% of patients and was achieved either by ultrasound (25%) or CT scan (75%). Operative findings consisted of normal appendix in 73 (45.4%) cases, uncomplicated appendicitis in 62 (38.5%) patients, and perforated appendix in 26 (16.1%). Regarding patients with appendicitis, mesh placement was reported for 17 (21.2%), herniorrhaphy was performed for 51 (63.7%) while 12 (15.1%) patients did not undergo hernia repair during the initial operation. Mesh utilization rates were significantly higher in patients with a normal appendix. Seven cases involved AH containing appendiceal neoplasms. Thirteen cases (8.6%) of postoperative complications were documented and a single case of postoperative death. CONCLUSION AH is a rare type of inguinal hernia usually complicated by appendicitis. Hernia reconstruction should be tailored to each patient individually according to the extent of inguinal canal inflammation.
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Affiliation(s)
- D Papaconstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece.
| | - Z Garoufalia
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - S Kykalos
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - C Nastos
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece
| | - D Tsapralis
- Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece
| | - O Ioannidis
- Fourth Department of Surgery, Aristotle University of Thessaloniki, General Hospital George Papanikolaou, Thessaloniki, Greece
| | - A Michalinos
- Department of Anatomy, European University of Cyprus, Nicosia, Cyprus
| | - G Chatzimavroudis
- Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Almetaher HA, Mansour MA, Arafa MA. Management of Amyand’s hernia in children: should appendectomy be mandatory or not? ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00021-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Abstract
Background
Amyand’s hernia (AH) is defined as protrusion of the vermiform appendix within the sac of the inguinal hernia and usually misdiagnosed as obstructed hernia. It is more common in pediatric patients but there are controversies about dealing with the normally looking appendix in AH. The aim of this study is to present our experience in the management of AH and highlights the difference in dealing with normally looking appendix between pediatric and adult patients. Patients’ demographics, intraoperative, and postoperative outcome were reported and analyzed.
Results
This is a retrospective analysis of 12 pediatric patients aged between 15 days and 5 years presented with AH and operated in tertiary referral hospital over 10 years. This study included 10 males and 2 females. The median age at the operation was 7 months. Eleven patients were operated using conventional technique, and only one patient was operated using laparoscopy. In 11 patients, the appendix was looking normal and was reduced without appendectomy, and the hernia was repaired. Appendectomy was done in one patient presented with AH containing inflamed appendix. The postoperative course was uneventful in all cases.
Conclusions
There is a difference in the management of pediatric and adult patients presenting with AH, and appendectomy is not mandatory in normally looking appendix in pediatric patients.
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Junttila A, Mattila AK. Amyand's hernia: acute appendicitis and abscess in the inguinal canal. BMJ Case Rep 2019; 12:12/7/e228725. [PMID: 31296635 DOI: 10.1136/bcr-2018-228725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Amyand's hernia is a rare entity where the appendix is trapped within inguinal canal. For even rarer are the cases where the appendix has perforated and caused an abscess into inguinal canal. Here we report a case where a male patient had Amyand's hernia, acute appendicitis and abscess which were treated by laparotomy. We present the diagnostic process and intraoperative finding leading to diagnosis of Amyand's hernia.
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Affiliation(s)
- Anna Junttila
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Anne K Mattila
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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Kromka W, Rau AS, Fox CJ. Amyand's hernia with acute gangrenous appendicitis and cecal perforation: A case report and review of the literature. Int J Surg Case Rep 2018; 44:8-10. [PMID: 29455120 PMCID: PMC5852383 DOI: 10.1016/j.ijscr.2018.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION An Amyand's hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand's hernia containing acute appendicitis and a perforated cecum. PRESENTATION OF CASE A 46-year-old male with a right inguinal hernia of 2-3 year duration presented to our Emergency Department complaining of acute onset abdominal and groin pain. The patient was diagnosed with an incarcerated right inguinal hernia and underwent emergent surgical repair. Intraoperatively a reactive fluid was found within the hernia sac that prompted an exploratory laparotomy for suspected bowel perforation. The hernia was then found to contain an inflamed gangrenous appendix with an inflamed and perforated cecum. An ileocecectomy and enteroenterostomy was performed and the hernia defect was repaired without mesh. DISCUSSION With an estimated incidence of only 1%, Amyand's hernias are rare and lack a clear evidence-based management scheme. Moreover, they can contain a diverse range of pathologic features and presentations that can complicate diagnosis and treatment. To avoid potential morbidity and mortality, the surgeon must consider an Amyand's hernia on his or her differential when operating on inguinal hernias and be aware of the associated presentations, complications, and management schemes. CONCLUSION There is a paucity of reports describing simultaneous appendicitis and cecal perforation within an Amyand's hernia. In our case, ileocecectomy and Bassini hernia repair with close follow-up led to a favorable outcome.
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Affiliation(s)
- William Kromka
- University of Colorado, School of Medicine, United States.
| | | | - Charles J Fox
- Denver Health and the University of Colorado, United States
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Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Perrakis E, Perrakis A. Incarcerated recurrent inguinal hernia containing an acute appendicitis (Amyand hernia): an extremely rare surgical situation. Arch Med Sci 2017; 13:702-704. [PMID: 28507592 PMCID: PMC5420623 DOI: 10.5114/aoms.2016.60403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/31/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Abstract
PURPOSE Presence of the vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. This may present as a tender inguinal swelling and is often misdiagnosed as irreducible or strangulated hernia. METHODS Between January 2003 and December 2013 we treated 4498 patients with inguinal hernias and performed 3267 appendectomies. Among these; 46 had an Amyand's hernia. Age, sex, presenting symptoms, treatment modality, histopathological findings, duration of hospitalization, and post-surgical outcomes were analyzed retrospectively. RESULTS All patients were boys. The mean age was 16.7months (15days-8years). 37 (80.4%) right, 2 (4.3%) left and 7 (15.2%) bilateral hernioplasties were performed. Nine patients underwent emergency surgery with an initial diagnosis of incarcerated hernia; Amyand's hernia was an incidental finding in the remaining 37 patients. Operative findings included 33 normal appendices, 9 inflamed appendices, one perforated appendix, and three appendices adherent to the hernia sac. Eighteen patients had appendectomy during hernia repair, and the other 33 had hernia repair without appendectomy. None of the patients developed recurrent hernia or appendicitis within the follow-up period. CONCLUSION In Amyand's hernia the appendix should be examined carefully. A classification of Amyand's hernia according to the presenting symptoms and inflammatory status of the appendix may help to determine whether or not to proceed with appendectomy.
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Al Maksoud AM, Ahmed AS. Left Amyand's hernia: An unexpected finding during inguinal hernia surgery. Int J Surg Case Rep 2015; 14:7-9. [PMID: 26196311 PMCID: PMC4573214 DOI: 10.1016/j.ijscr.2015.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/22/2015] [Accepted: 06/27/2015] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Amyand's hernia is a rare finding of the appendix inside an inguinal hernia sac with classically estimated incidence of 1%. Most cases are found intra-operatively during right-sided inguinal hernia repair. PRESENTATION OF CASE We are reporting a very rare case of left-sided Amyand's hernia. An 81 year-old man with long standing left inguinal hernia was referred to our surgical assessment unit with tender irreducible left inguinal hernia. He was vitally stable with no clinical signs of intestinal obstruction. A diagnosis of irreducible left inguinal hernia without obstruction was made. Exploration of the hernia sac revealed the presence of non-inflamed appendix, caecum and terminal ileum. The contents were reduced and a mesh repair was performed with satisfactorily outcome. DISCUSSION The surgical management of Amyand's hernia involves appendectomy of inflamed appendix through the inguinal incision together with hernia repair. Prophylactic appendectomy is not recommended by most authors except in young patients. CONCLUSION There are less than 20 cases reported in the literature describing left-sided Amyand's hernia. Awareness of such very unusual condition may help surgeons to be prepared for appropriate management of a very usual procedure as inguinal hernia repair.
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Karanikas I, Ioannidis A, Siaperas P, Efstathiou G, Drikos I, Economou N. Incarcerated Amyand hernia with simultaneous rupture of an adenocarcinoma in an inguinal hernia sac: a case report. J Med Case Rep 2015; 9:120. [PMID: 26018608 PMCID: PMC4470008 DOI: 10.1186/s13256-015-0592-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/08/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION An Amyand's hernia is a rare occurrence of an inguinal hernia, with an estimated prevalence of 1%. The major complications of an Amyand's hernia include necrotizing fasciitis of the anterior abdominal wall and secondary intestinal perforation. Though the incidence of this type of hernia is low, the appendix may easily become initially incarcerated, possibly leading to strangulation and perforation. CASE PRESENTATION A 92-year-old female patient presented to our emergency department with clinical signs of an incarcerated right inguinal hernia, accompanied by fever. A clinical examination revealed localized abdominal pain, reflecting to the right side of her groin. Laboratory tests showed leukocytosis (13,200/μL), while an abdominal X-ray showed colon distension with evidence of intestinal obstruction. Ultrasonography was performed and confirmed the presence of an inflamed tubular structure inside her right inguinal canal. Our patient underwent emergency surgery. We started with a right inguinal incision, which revealed an incarcerated right inguinal hernia, containing her ruptured appendix and showing macroscopic evidence of malignancy. A specimen biopsy was immediately performed and the results showed a ruptured cecal adenocarcinoma. The incision was slightly extended upwards, and a right hemicolectomy performed. CONCLUSIONS Diagnosis of an Amyand's hernia occurs primarily as an incidental finding during surgery and the optimal therapeutic approach must be considered individually for each case. Owing to the rarity of Amyand's hernia and the wide variance of its clinical characteristics, every case provides useful information toward the treatment of this type of hernia.
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Affiliation(s)
- Ioannis Karanikas
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1, P.O. BOX 15126, Athens, Greece.
| | - Argyrios Ioannidis
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1, P.O. BOX 15126, Athens, Greece.
| | - Petros Siaperas
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1, P.O. BOX 15126, Athens, Greece.
| | - Georgios Efstathiou
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1, P.O. BOX 15126, Athens, Greece.
| | - Ioannis Drikos
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1, P.O. BOX 15126, Athens, Greece.
| | - Nicolaos Economou
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1, P.O. BOX 15126, Athens, Greece.
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Ciftci F, Abdulrahman I. Incarcerated amyand hernia. World J Gastrointest Surg 2015; 7:47-51. [PMID: 25848493 PMCID: PMC4381157 DOI: 10.4240/wjgs.v7.i3.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/08/2014] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
Amyand’s hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated inguinal hernia generally masks the symptoms and signs of acute appendicitis, which renders preoperative diagnosis difficult. In this study, we present two cases of Amyand’s hernia that were diagnosed preoperatively. The patients were taken for operation with the prediagnosis of ıncarcerated inguinal hernia. We evaluated these cases along with data from prior studies.
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Abstract
The authors suggest that patients with atypical presenting features of hernia undergo a transabdominal approach to groin hernia repair because of greater diagnostic potential, rather than an extraperitoneal technique. A wide range of diagnoses can present as inguinal hernia. Laparoscopic techniques are being increasingly used in the repair of inguinal hernias and offer the potential benefit of identifying additional pathology. The authors present the first reported case of a hydrocele of the canal of Nuck diagnosed laparoscopically. We review the incidence of identifying additional pathology through laparoscopy for inguinal hernia repair. We suggest that in patients with atypical presenting features of a hernia, the transabdominal preperitoneal, rather than a totally extraperitoneal, approach to groin hernia repair should be considered because of its greater diagnostic potential.
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Affiliation(s)
- David Bunting
- Department of General Surgery, Royal Cornwall Hospital, Truro, Cornwall, UK.
| | - Lukasz Szczebiot
- Department of General Surgery, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - Alwyn Cota
- Department of General Surgery, Royal Cornwall Hospital, Truro, Cornwall, UK
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Amyand's hernia: a hybrid laparoscopic and open approach. Hernia 2014; 19:991-4. [PMID: 24638818 DOI: 10.1007/s10029-014-1233-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
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Ivanschuk G, Cesmebasi A, Sorenson EP, Blaak C, Loukas M, Tubbs SR. Amyand's hernia: a review. Med Sci Monit 2014; 20:140-6. [PMID: 24473371 PMCID: PMC3915004 DOI: 10.12659/msm.889873] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
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.
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Affiliation(s)
- Galyna Ivanschuk
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Alper Cesmebasi
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Edward P Sorenson
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Christa Blaak
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Shane R Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, USA
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Michalinos A, Moris D, Vernadakis S. Amyand's hernia: a review. Am J Surg 2013; 207:989-95. [PMID: 24280148 DOI: 10.1016/j.amjsurg.2013.07.043] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/20/2013] [Accepted: 07/02/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. The aim of this systematic review was to gather information concerning its prevalence, clinical image, diagnosis, and treatment. DATA SOURCES The MEDLINE database was thoroughly searched using the keyword "Amyand's hernia." Additional articles were gathered and evaluated. CONCLUSIONS The true prevalence of Amyand's hernia seems lower than classically described. Its usual clinical image is identical to that of an incarcerated hernia, and thus it is almost impossible to diagnose preoperatively, although ultrasound and computed tomography can help. Treatment includes hernioplasty with or without appendectomy and/or mesh repair depending on the vermiform appendix's inflammation status, the patient's general condition, and other factors. Amyand's hernia generally has a good prognosis, although serious complications have been described. Surgeons should be prepared if they encounter Amyand's hernia because appropriate treatment ensures hernia repair without complications and with avoidance of recurrence.
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Affiliation(s)
- Adamantios Michalinos
- 1st Department of Surgery, Athens University School of Medicine, "Laikon" University Hospital, 2nd Floor, Agiou Thoma 17 Str, Goudi, Athens, Greece; Department of General and Transplantation Surgery, "Laikon" General University, Athens, Greece.
| | - Demetrios Moris
- 1st Department of Surgery, Athens University School of Medicine, "Laikon" University Hospital, 2nd Floor, Agiou Thoma 17 Str, Goudi, Athens, Greece; Department of General and Transplantation Surgery, "Laikon" General University, Athens, Greece
| | - Spiridon Vernadakis
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany; Department of General and Transplantation Surgery, "Laikon" General University, Athens, Greece
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Okur MH, Karaçay S, Uygun I, Topçu K, Öztürk H. Amyand's hernias in childhood (a report on 21 patients): a single-centre experience. Pediatr Surg Int 2013; 29:571-4. [PMID: 23417545 DOI: 10.1007/s00383-013-3274-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Amyand's hernia is a very rare type of hernia and is characterised by the presence of a vermiform appendix in the inguinal hernia sac. It may present as a tender inguinal or inguinoscrotal swelling, and is usually misdiagnosed as an irreducible or strangulated inguinal hernia. This is a presentation of our experiences with these unusual hernias. METHODS This study conducted a retrospective analysis of 21 patients with Amyand's hernias operated on at our institution between April 2007 and February 2011. The age and sex distributions of the patients, the types of hernias, and preoperative diagnostic tests were evaluated. RESULTS Twenty patients were male (95.3 %) and one was female (4.7 %). The median age was 20.3 months (ranging from 2 months to 10 years). In nine patients, the conditions were diagnosed using ultrasonographic (USG) imaging preoperatively. Nine of the 21 patients underwent emergency operations. The 12 remaining patients were operated on after preparations were completed. The operative findings included 12 normal appendixes, five inflamed appendixes, one perforated appendix, and three hernias whose inner hernia sac surface was adhered to the appendix. Nine patients underwent inguinal hernia repair with appendectomy, and 12 patients had hernia repair without an appendectomy. Recurring hernias and appendicitis were not detected in any patients within the follow-up time. CONCLUSIONS Although a routine appendectomy is not required for a normal-looking appendix, in a case where the inflammatory status of the appendix adheres to the surface of the hernia sac, an appendectomy is required. We believe that USG examination in the diagnosis of Amyand's hernias can provide additional contribution.
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Kevorkian N, Rennie C, Asarian A, Pappas P. Left inguinal appendix in an HIV patient: A case report and review of literature. Int J Surg Case Rep 2013; 4:293-5. [PMID: 23380372 DOI: 10.1016/j.ijscr.2012.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/05/2012] [Accepted: 12/23/2012] [Indexed: 10/27/2022] Open
Abstract
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.
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Affiliation(s)
- Noubar Kevorkian
- The Brooklyn Hospital Center, Department of Surgery, 121 DeKalb Ave., Brooklyn, NY 11201, United States.
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Sengul I, Sengul D, Aribas D. An elective detection of an Amyand's hernia with an adhesive caecum to the sac: Report of a rare case. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 3:391-3. [PMID: 22171249 PMCID: PMC3234147 DOI: 10.4297/najms.2011.3391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Context: Existence of non-inflamed or inflamed vermiform appendix in an inguinal hernia is named Amyand's hernia in honor to the surgeon Claudius Amyand who successfully performed first perforated appendicitis. Case Report: A 69-year-old Turkish male patient with a slight right groin pain and swelling was presented to our clinic, and found to have a slightly tender and reducible right inguinal hernia. He underwent surgery under general anesthesia, and a adhesive caecum and an inflamed appendix were explored within the hernia sac. Adhesions were divided by sharp dissection and appendectomy was performed. After carrying out a Lichtenstein hernioplasty, a broad-spectrum antibiotic was postoperatively admitted for 3 days. He recovered uneventfully, and neither complication nor recurrence was detected during 52 months of follow-up. Conclusions: Although occurrence of an appendicitis in an inguinal hernia is rare, a surgeon should be vigilant for facing with it even in elective cases. Treatment can be provided only surgically, but surgical treatment is not standard except from appendectomy. In our opinion, application of mesh hernia repair should depend on the degree of inflammation of appendix and the presence of incarceration of hernia sac with a suitable antibiotic admission for 3-5 days postoperatively.
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Affiliation(s)
- Ilker Sengul
- Department of General Surgery, Giresun University Faculty of Medicine, 28100 Giresun, Turkey
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Burgess PL, Brockmeyer JR, Johnson EK. Amyand hernia repaired with Bio-A: a case report and review. JOURNAL OF SURGICAL EDUCATION 2011; 68:62-66. [PMID: 21292218 DOI: 10.1016/j.jsurg.2010.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/07/2010] [Accepted: 09/13/2010] [Indexed: 05/30/2023]
Abstract
A 53-year-old man with an Amyand hernia with indirect and direct components was repaired with a Bio-A (Gore, Newark, Delaware) plug and a patch made of Bio-A tissue reinforcement material. The repair of an Amyand hernia addresses the pathology of the appendix as well as the hernia. We report a case in which a plug and patch repair was undertaken using Bio-A implants in a clean-contaminated field with no signs of infection or recurrence in the follow-up period, and we review the literature regarding the diagnosis and repair of an Amyand hernia.
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Affiliation(s)
- Pamela L Burgess
- Dwight David Eisenhower Army Medical Center, Ft. Gordon, Georgia 30905, USA.
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Ioannidis O, Styliani P, Kakoutis E, Rafail S, Chatzopoulos S, Konstantara A, Makrantonakis N. Strangulation of the Vermiform Appendix within a Right Inguinal Hernia: A Rare Variation of Amyand's Hernia. Am Surg 2010. [DOI: 10.1177/000313481007601139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orestis Ioannidis
- General Regional Hospital “George Papanikolaou” Thessaloniki, Greece
| | | | | | - Stergios Rafail
- General Regional Hospital “George Papanikolaou” Thessaloniki, Greece
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Park J, Hemani M, Milla SS, Rivera R, Nadler E, Alukal JP. Incarcerated Amyand's hernia in a premature infant associated with circumcision: a case report and literature review. Hernia 2009; 14:639-42. [PMID: 20012455 DOI: 10.1007/s10029-009-0599-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 11/13/2009] [Indexed: 11/28/2022]
Abstract
Amyand's hernia is a rare presentation of an appendix within an inguinal hernia sac. It is commonly mistaken for an incarcerated or strangulated hernia. Prompt diagnosis requires awareness of this entity, as well as associated radiologic findings on computed tomography (CT) and ultrasound. Treatment includes antibiotics and surgical intervention involving appendectomy and hernia repair. We present a case of a premature infant who developed systemic symptoms after a circumcision and was eventually diagnosed with an Amyand's hernia with concurrent appendicitis.
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Affiliation(s)
- J Park
- School of Medicine, SUNY at Stony Brook, Stony Brook, NY, USA.
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Amyand’s hernia: a series of 30 cases in children. Hernia 2009; 13:609-12. [PMID: 19626272 DOI: 10.1007/s10029-009-0528-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
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Küper MA, Kischniak A, Königsrainer A, Granderath FA. The role of prosthetic repair in the treatment of an incarcerated recurrent inguinal hernia with acute appendicitis (inflamed Amyand’s hernia). Hernia 2009. [DOI: 10.1007/s10029-009-0482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chatzimavroudis G, Papaziogas B, Koutelidakis I, Tsiaousis P, Kalogirou T, Atmatzidis S, Atmatzidis K. The role of prosthetic repair in the treatment of an incarcerated recurrent inguinal hernia with acute appendicitis (inflamed Amyand's hernia). Hernia 2009; 13:335-6; author reply 337. [PMID: 19418014 DOI: 10.1007/s10029-009-0505-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 04/23/2009] [Indexed: 01/26/2023]
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Ikeda S, Takeda H, Yoshimitsu M, Hinoi T, Yoshida M, Sumitani D, Takakura Y, Kawaguchi Y, Shimomura M, Tokunaga M, Kawahori K, Ohdan H, Okajima M. Abscess in the inguinal hernial sac after peritonitis surgery: A case report. World J Gastroenterol 2009; 15:1007-9. [PMID: 19248203 PMCID: PMC2653403 DOI: 10.3748/wjg.15.1007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In this paper, we report an extremely rare case of an abscess that developed in the inguinal hernial sac after surgery for peritonitis. A 60-year-old man underwent laparoscopic low anterior resection for rectal cancer. One day after this operation, peritoneal drainage and ileostomy were performed for rectal anastomotic leakage. Five days after the second operation, computed tomography revealed an abscess in the left inguinal hernial sac. Subsequently, hernioplasty and resection of the inflamed sac were performed.
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Rare cause of acute pain in the left upper abdominal quadrant. Hernia 2008; 12:659-61. [PMID: 18491204 DOI: 10.1007/s10029-008-0382-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 04/22/2008] [Indexed: 10/22/2022]
Abstract
We report a case of a 45-year-old man with acute pain in the left upper abdominal quadrant. Extensive diagnostic workup remained inconclusive. An exploratory laparotomy revealed herniation of the entire ascending colon, together with a part of the terminal ileum through the foramen of Winslow into the bursa omentalis. The internal hernia was further complicated by a perforated appendicitis within the bursa, explaining the acuteness of the symptoms. Reduction of the hernia, appendectomy and colopexy were performed consequently. This would be the first reported case of a perforated appendicitis within the lesser sack.
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