Bilateral congenital inguinal hernia with right-sided Amyand's hernia in a premature twin: Case report and a summary of clinical presentations, management and outcomes in neonates and infants with Amyand's hernia

Agha R.A., Franchi T., Sohrabi C., Mathew G., Kerwan A., Thoma A., Beamish A.J., Noureldin A., Rao A., Vasudevan B., Challacombe B., Perakath B., Kirshtein B., Ekser B., Pramesh C.S., et. al.

The SCARE Guidelines were first published in 2016 and were last updated in 2018. They provide a structure for reporting surgical case reports and are used and endorsed by authors, journal editors and reviewers, in order to increase robustness and transparency in reporting surgical cases. They must be kept up to date in order to drive forwards reporting quality. As such, we have updated these guidelines via a DELPHI consensus exercise. The updated guidelines were produced via a DELPHI consensus exercise. Members were invited from the previous DELPHI group, as well as editorial board members and peer reviewers of the International Journal of Surgery Case Reports. The expert group completed an online survey to indicate their agreement with proposed changes to the checklist items. A total of 54 surgical experts agreed to participate and 53 (98%) completed the survey. The responses and suggested modifications were incorporated into the new 2020 guideline. There was a high degree of agreement amongst the SCARE Group, with all modified SCARE items receiving over 70% scores 7–9. A DELPHI consensus exercise was completed and an updated and improved SCARE Checklist is now presented. • This was a DELPHI consensus exercise to update the SCARE guidelines. • Of the invited surgical experts, 53 (98%) completed the survey. There was a high level of agreement within the SCARE Group. • The survey responses were incorporated as modifications, and an improved SCARE Checklist is now presented for use.

Omran A., Gawrieh B.S., Abdo A., Ali Deeb M., Khalil M.A., Shater W.

Abstract The presence of vermiform appendix in an inguinal hernia sac is known as Amyand’s hernia. This research paper examines the case of a 28-day-old Syrian male presented with a history of an infected right-sided hydrocele from the age of 14 days. Upon admission, ultrasonography was reported as a right testicular torsion. Accordingly, emergency surgical exploration was performed, and by exposing the spermatic cord fascia, 7 mL of pus was drained, revealing the cecum and perforated appendix lying beside the right testis, which showed evidence of ischemia and bluish discoloration.

Mohamed A., Fagelnor A.

AbstractThe presence of the vermiform appendix, whether inflamed or not, inside a hernial sac is known as Amyand's hernia. Due to nonspecific signs, preoperative diagnosis is not common and requires a high index of suspicion along with awareness of this rare entity. It is more commonly mistaken for a strangulated or incarcerated inguinal hernia. Most cases of reported Amyand's hernia with appendicitis were in pre-term babies, infants, and post-menopausal women. We present a similar case in a 19-day-old, full-term baby presenting with inguinoscrotal edema, erythema, and without a palpable inguinoscrotal mass.

Fascetti-Leon F., Sherwood W.

Erginel B., Soysal F.G., Celik A., Salman T.

Appendicitis in newborns is uncommon and difficult to diagnose. Reports on neonatal appendicitis subsequent to inguinal hernia incarceration are exceptionally rare. We present the case of a 26-day-old infant with perforated appendicitis due to incarceration of a right inguinal hernia, mimicking right testicular torsion.

Cigsar E.B., Karadag C.A., Dokucu A.I.

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.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.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.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.

Panagidis A., Sinopidis X., Zachos K., Alexopoulos V., Vareli A., Varvarigou A., Georgiou G.

Perforation of the vermiform appendix in a septic neonate with an Amyand's hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant.

Raveenthiran V.

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Mandhan P., Al Rayes T., Ali M.J., Aldhaheri M.

Amyand’s hernia is a rare clinical entity in which the vermiform appendix is present within the inguinal hernia sac. Here, we report a 5-day-old neonate with dysmorphic features referred to us with a tender irreducible right inguino-scrotal swelling. Surgical exploration showed gangrenous appendix with a peri-appendicular abscess in the inguinal hernia sac. Appendectomy and right herniotomy was performed.

Ergaz Z., Simanovsky N., Vromen A., Meir K., Bar-Oz B.

We present a case of Amyand’s hernia with perforated appendicitis in a premature infant. The favorable outcome compared to perforated abdominal appendicitis is discussed. Despite its rarity, this diagnosis should be considered in the differential diagnosis of a scrotal mass in premature infants.

Esposito C., Iaquinto M., Escolino M., Settimi A.

Wang K.S., Papile L., Baley J.E., Benitz W., Cummings J., Carlo W.A., Kumar P., Polin R.A., Tan R.C., Watterberg K.L., Brandt M.L., Shamberger R.C., Caty M.G., Heiss K.F., Holcomb G.W., et. al.

Inguinal hernia repair in infants is a routine surgical procedure. However, numerous issues, including timing of the repair, the need to explore the contralateral groin, use of laparoscopy, and anesthetic approach, remain unsettled. Given the lack of compelling data, consideration should be given to large, prospective, randomized controlled trials to determine best practices for the management of inguinal hernias in infants.

Ngom G., Amadou I., Ibrahima K.A., Mubake A., Ndour O., Ndoye M.

Inguinal hernia with acute appendicitis known as Amyand9s hernia is uncommon. It occurs mostly in adults, older children and infants. The appendix inside the hernial sac is rarely perforated. The authors describe in a neonate aged 14 days an unusual case of inguinal hernia containing a perforated appendix that was clinically considered as a strangulated inguinal hernia. Surgery performed with an inguinal approach permitted us to remove the appendix and close the hernial sac. The postoperative course was uneventful after a follow-up of 1 year.

Park J., Hemani M., Milla S.S., Rivera R., Nadler E., Alukal J.P.

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.

Klyuev S., Azizoğlu M.

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.