The left-sided location of Amyand hernia in a 2-year-old child

EDITORIAL COMMENT. The symptom complex presented in the article (a syndrome of edematous hyperemic scrotum in a child with an irreducible left-sided hernia) was undoubtedly an indication for emergency surgical treatment. The cause of the left-sided localization of Amiand hernia requires additional examination – irrigography.

Introduction. Amyand hernia or inguinal hernia is the hernia in which the vermiform appendix is located within the hernial sac. There are still debates among researchers what is a true Amyand hernia – strangulation of the vermiform process in the hernial sac of an inguinal or postoperative hernia with its development into gangrenous appendicitis or an inguinal hernia with non-inflamed, or inflamed-altered, or perforated vermiform process. Debates on the surgical treatment, reasonability of appendectomy with an unchanged appendix in the hernial sac and ways of hernia repair are still controversial too. Unfortunately, decisions often have to be made right during surgery since the revealing of vermiform process and its morphology in the hernial sac before surgery is a problematic issue.

Literature describes cases of similar hernias, both in adults and in children, but with the right-sided location. Amyand hernias are seen, by different authors, in 0.07–0.13 to 2–4%.

Relevance. In the available medical literature, there is no any description of such hernia with the left-sided location, so the authors have considered it appropriate to publish a rare clinical case.

Objective. To analyze a rare case of the left-sided inguinal-scrotal hernia with a destructive vermiform process in the hernial sac and to identify possible diagnostic and therapeutic errors occurred during medical care.

Material and methods. Clinical case: a 2-year and 8 months old child was admitted to the hospital having emergency symptoms of a left-sided strangulated inguinal-scrotal hernia with a gangrenous-altered vermiform process in the hernial sac and concomitant acute pharyngitis. Anamnesis: child from the first pregnancy which was accompanied by moderate preeclampsia; chronic arterial hypertension of degree II, risk 2; mitral valve prolapse of degree II–III; mild anemia; placental disorders; threats of pregnancy termination. The child was born at 27–28 week gestation with the Caesarean section. It had an extremely low body weight (610 grams), bronchopulmonary dysplasia, congenital pneumonia.

Conclusion. Amyand hernia is an insidious pathology. It has specific clinical manifestations, specific anamnesis and child’s life; it is difficult for diagnostics and can lead to tactical mistakes which are described in the given clinical case as an example.