Amyand’s hernia in the pediatric population

A three-case series and surgical management

Abstract

Amyand’s hernia (AH) is an uncommon entity defined by the presence of the vermiform appendix within the inguinal hernia sac, with an estimated incidence ranging from 0.19% to 1.7% of all repaired inguinal hernias. It is three times more common in the pediatric population than in adults; its higher prevalence is attributed to the patency of the processus vaginalis, which facilitates the displacement of he appendix into the inguinal canal. We present a series of three male patients, aged 26 days, 6 months, and 10 months, treated in the Pediatric Surgery Department of the Dr. Francisco de Icaza Bustamante Hospital. 
The diagnosis was established intraoperatively in all three  cases, two of which involved emergency admission due to obstructive symptoms, while the neonate underwent  elective surgery. Intraoperative findings of the appendix  ranged from acute inflammatory changes with hyperemia and edema without perforation to vascular compromise  with partial necrosis. Surgical management was individualized according to the Losanoff and Basson  classification, with transhernial appendectomy in all three patients and hernia repair by herniotomy and high ligation of the sac without prosthetic material. Postoperative evolution was satisfactory in all cases, with no complications during follow-up. This series confirms the need for pediatric surgeons to be familiar with this entity, since intraoperative diagnosis requires an immediate decision regarding the appendix and the repair of the defect.