PEDİATRİK YAŞTA AMYAND HERNİ: TEK CERRAH DENEYİMİ

Year 2020, Volume: 27 Issue: 3, 403 - 408, 01.09.2020

Yasemin Günal

https://doi.org/10.17343/sdutfd.769808

Abstract

Amaç
Amyand herni, inguinal herni kesesinde apendix vermiformisin varlığı ile karakterize nadir görülen bir herni türüdür. Çoğunlukla, inkarsere inguinal herni ön tanısı ile ameliyat edilen hastalarda tesadüfen tanı konulur. Bu nadir patoloji hakkındaki deneyimin sunulması amaçlandı.
Gereç ve Yöntem
Bu çalışmada 2011-2017 tarihleri arasında tek bir çocuk cerrahı tarafından ameliyat edilen on Amyand hernili çocuk hastanın retrospektif bir analizi yapıldı. Hastaların demografik özellikleri (yaş, cinsiyet), başvuru şikayetleri, tedavi yöntemleri, histopatolojik bulguları ve postoperatif sonuçları değerlendirildi.
Bulgular
Amyand hernili tüm hastalar erkekti. Yaş ortalaması 12.02 aydı (17 gün-8 yaş). Hepsinde sağ inguinal herni mevcuttu. Hastaların 4’üne inkarsere inguinal herni ön tanısıyla acil cerrahi uygulandı. Geri kalan 6 hasta, elektif herni onarımı sırasında tesadüfen tanı aldı. Dokuz hastaya konvansiyonel herni onarımı yapıldı ve sadece bir hasta laparoskopi kullanılarak ameliyat edildi. Ameliyat bulguları 7 hastada normal apendiks ve 3 hastada inflame apendiksti. Apendiksi fıtık kesesine yapışık olan 3 hastanın ikisinde inflame apandisit birinde lenfoid hiperplazi saptandı. Dört hastada inguinal herni onarımı sırasında apendektomi, diğer 6 hastada apendektomi yapılmadan herni onarımı yapıldı. Hiçbir hastada tekrarlayan fıtık görülmedi.
Sonuç
Sağ inguinal hernisi olan hastaların ayırıcı tanısında Amyand hernisi unutulmamalıdır. Fıtık kesesine yapışan apendiksin inflamasyon durumu uygun bir tedavi kararı verebilmek için dikkatle değerlendirilmelidir.

Keywords

inguinal, amyand herni, çocuk, apendektomi

AMYAND’S HERNIA IN PEDIATRIC AGE: A SINGLE SURGEON EXPERIENCE

Abstract

Objective
Amyand's hernia is the presence of appendix in the hernia sac and is rarely seen. The diagnosis is mostly made incidentally during the operation performed due to the incarcerated inguinal hernia. It was aimed to present the experience about this rare pathology.
Material and Method
Analysis of 10 children with Amyand's hernia operated by a single pediatric surgeon between 2011 and 2017 was performed, retrospectively. Demographic features (age, gender), complaints, treatment methods, histopathological findings and postoperative results were evaluated.
Results
All patients were male. The average age was 12.02 months (17 days-8 years). All had a right inguinal hernia. Emergency surgery was performed in 4 of the patients with an initial diagnosis of incarcerated inguinal hernia. The remaining 6 patients were diagnosed incidentally during elective hernioplasty. While 9 patients were treated with conventional hernia repair, only one patient underwent laparoscopy. Surgical findings included 7 normal appendices ve 3 inflamed appendices. Of 3 patients with appendix adhered to the hernia sac, 2 has appendicitis and 1 has lymphoid hyperplasia. Appendectomy was performed during inguinal hernia repair in 4 patients and hernia repair was performed in 6 patients without appendectomy. Recurrent hernias were not observed in any patients.
Conclusion
Amyand's hernia should be kept in mind in the differential diagnosis of patients with right inguinal hernia. The inflammation status of appendix adhering to the hernia sac should be carefully evaluated for an appropriate treatment decision.

Keywords

Inguinal, Amyand's hernia, Child, Appendectomy

References

• 1. Hutchinson R. Amyand's hernia. J R Soc Med. 1993;86(2):104-5.
• 2. Sharma H, Gupta A, Shekhawat NS, Memon B, Memon MA. Amyand's hernia: a report of 18 consecutive patients over a 15-year period. Hernia. 2007;11(1):31–5.
• 3. Almetaher HA, Mansour MA, Arafa MA. Management of Amyand’s hernia in children: should appendectomy be mandatory or not?. Annals of Pediatric Surgery. 2020;16:14. doi: 10.1186/s43159-020-00021-3
• 4. Patoulias D, Kalogirou M, Patoulias I. Amyand's Hernia: an Up-to-Date Review of the Literature. Acta Medica (Hradec Kralove). 2017;60(3):131-4.
• 5. Bakhshi GD, Bhandarwar AH, Govila AA. Acute appendicitis in left scrotum. Indian J Gastroenterol. 2004;23(5):195.
• 6. Vermillion JM, Abernathy SW, Snyder SK. Laparoscopic reduction of Amyand’s hernia. Hernia 1999;3:159–60.
• 7. Cigsar EB, Karadag CA, Dokucu AI. Amyand's hernia: 11years of experience. J Pediatr Surg. 2016;51(8):1327–9.
• 8. Okur MH, Karacay S, Uygun I, Topcu K, Ozturk H. Amyand ’s hernias in childhood (a report on 21 patients): a single-centre experience. Pediatr Surg Int. 2013;29(6):571–4.
• 9. Cankorkmaz L, Ozer H, Guney C, Atalar MH, Arslan MS, Koyluoglu G. Amyand’s hernia in the children: a single center experience. Surgery. 2010;147(1):140–3.
• 10. Priego P, Lobo E, Moreno I, Sanchez-Picot S, Gil Olarte MA, Alonso N, et al. Acute appendicitis in an incarcerated crural hernia: analysis of our experience. Rev Esp Enferm Dig. 2005;97(10):707 –15.
• 11. Gurer A, Ozdogan M, Ozlem N, Yildirim A, Kulacoglu H, Aydin R. Uncommon content in groin hernia sac. Hernia. 2006;10(2):152 –5.
• 12. Lao OB, Fitzgibbons RJ, Cusick RA. Pediatric surgery pediatric inguinal hernias, hydroceles, and undescended testicles. Surg Clin North Am. 2012;92(3):487-504.
• 13. Fu YW, Pan ML, Hsu YJ, Chin TW. A nationwide survey of incidence rates and risk factors of inguinal hernia in preterm children. Pediatr Surg Int. 2018;34(1):91–5.
• 14. Pan ML, Chang WP, Lee HC, Tsai HL, Liu CS, Liou DM, et al. A longitudinal cohort study of incidence rates of inguinal hernia repair in 0- to 6-year-old children. J Pediatr Surg. 2013;48(11):2327–31.
• 15. Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review J Pediatr Surg. 2006;41(5):980-6.
• 16. Michalinos A, Moris D, Vernadakis S. Amyand’s hernia: a review. The American Journal of Surgery. 2014;207(6):989-95.
• 17. Bar-Maor JA, Zeltzer M. Acute appendicitis located in a scrotal hernia of a premature infant J Pediat Surg. 1978;13(2):181-2.
• 18. Abu-Dalu J, Urca I. Incarcerated inguinal hernia with a perforated appendix and periappendicular abscess: report of a case. Dis Colon Rectum. 1972;15(6):464-5.
• 19. Weber RV, Hunt ZC, Kral JC. Amyand's hernia. Etiologic and therapeutic implications of two complications. Surg Rounds. 1999;22:552-6.
• 20. Ofili OP. Simultaneous appendectomy and inguinal herniorrhaphy could be beneficial. Ethiop Med J. 1991;29(1):37-8.
• 21 Gündüz M. Amyand’s Hernia in Children. Haydarpaşa Numune Medical Journal. 2018;58(1):45-7.
• 22. Tisdale JB, Barwell NJ. Amyand's hernia and peri-appendicular abscess in primary care. Hernia. 2008;12(3):311-2.
• 23. Celik A, Ergün O, Ozbek SS, Dökümcü Z, Balik E. Sliding appendiceal inguinal hernia: preoperative sonographic diagnosis. J Clin Ultrasound. 2003;31(3):156-8.
• 24. Inan I, Myers PO, Hagen ME, Gonzalez M, Morel P. Amyand's hernia: 10 years' experience. Surgeon. 2009;7(4):198–202.
• 25. Ash L, Hatem S, Ramirez GA, Veniero J. Amyand's hernia: a case report of prospective ct diagnosis in the emergency department. Emerg Radiol. 2005;11(4):231-2.
• 26. Kaymakci A, Akillioglu I, Akkoyun I, Guven S, Ozdemir A, Gulen S. Amyand's hernia: a series of 30 cases in children. Hernia. 2009;13(6):609-12.
• 27. Rehman MR, Panteli C, Tsang T. Laparoscopic repair of Amyand’s hernia in an 8-week-old infant. Hernia. 2010;14(4):443-5.
• 28. Tycast JF, Kumpf AL, Schwartz TL, Coln CE. Amyand’s hernia: a case report describing laparoscopic repair in a pediatric patient. J Pediatr Surg. 2008;43(11):2112-2114.
• 29. Li B, Zhang JY, Wang YB, et al. Laparoscope-assisted diagnosis and treatment for Amyand's hernia in children-report of six cases. Pediatr Surg Int. 2013;29(5):525-8.