Amyand’s Hernia in an Infant: A Case Report and Review of Literature

Abstract

Introduction: Inguinal hernia is a common surgical disease among a pediatric population with patent processus vaginalis being the major risk factor. Omentum and small intestine loops are the oftenencountered hernia sac contents, however in a rare instance (1% of cases), a vermiform appendix is found in the sac, and it is referred as Amyand’s hernia (AH). The appendix can be normal, inflamed, strangulated, or perforated. Case presentation: 7-week-old male baby with 2-week history of right groin swelling, excessive crying and restlessness. He was clinically stable with irreducible right inguinoscrotal swelling. An ultrasonography confirmed a 1.5 cm abdominal wall defect with bowels in the sac. A clinical diagnosis of incarcerated inguinal hernia was made, and the patient was prepared for surgery. A standard herniotomy incision was done, hernia sac was found and opened and appendix and cecum were found. The contents were reduced, the sac was ligated and transected, and the incision was closed in layers. The post-operative follow ups were uneventful. Discussion: AH is a rare condition, with estimated prevalence of 0.19% to 1.7% and 0.1% occurrence of appendicitis. The clinical presentations of AH include painful groin swelling, inguino-scrotal erythema, tenderness, and features of obstructed or strangulated inguinal hernia. Diagnosis is often made during surgery as it is exceedingly difficult to diagnose it pre-operatively as it resembles inguinal hernia, and it can mimic testicular torsion or inflammation in case of erythema and tenderness. The surgical approach depends on the status of appendix, and it can be reduction of appendix or appendectomy if inflamed. Conclusions: Although rare, an index of suspicion should be kept in all inguinal hernia repairs. The appendix should be preserved if normal as with emergence of novel surgical technologies, the appendix can be of significant use especially for the children.