Amyand's hernia in children

Amyand's Hernia (AH) is a rare entity described as the presence of the vermiform appendix in an inguinal hernial sac. Though its prevalence is three times more in children than adults, owing to the presence of patent processus vaginalis, its occurrence with acute appendicitis is more uncommon in children, especially in infants. Seldom diagnosed correctly ahead of surgical exploration, it is often clinically diagnosed as an incarcerated inguinal hernia or as a case of acute scrotum. The management of such cases depends upon the per-operative findings. In this series, we report four cases of AH treated at King Saud Medical City Hospital Riyadh between 2018 and 2022. All the four patients were male and three of them were infants. Three patients had right sided hernia, while one had bilateral inguinal hernia. One of the patients was diagnosed with strangulated hernia and upon exploration it was AH with acute appendicitis and appendectomy was done. One child had recurrent, irreducible hernia and upon exploration, found appendix densely adherent to the hernial sac. Another patient had early suppurative inflammation at the tip, while the patient with bilateral hernias had appendix adherent to the right hernial sac. In all our cases appendectomy was performed either due to inflammation or adhesions. There is a rarity of this condition and few cases have been reported in the literature. Such cases need to be reported to keep the surgeons aware of this condition and its different manifestations. Herein, we aim to share our experience of four cases of AH with varied presentations and a literature review.