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Amyand’s hernia with healthy looking vermiform appendix, treatment of three cases with review of literatures
فتق " أمياند" المحتوي على زائده دوديه غير ملتهبه, علاج ثلاث حالات مع مراجعة البحوث السابقه

Author: Nabil I. Naiem نبيل عصام نعيم
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2018 Volume: 60 Issue: 3 Pages: 174-178
Publisher: Baghdad University جامعة بغداد

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Abstract

The term Amyand’s hernia refers to an incarcerated inguinal hernia containing the vermiform appendix,which may be completely healthy, inflamed or perforated. (1)Amyand’s hernia is named after Claudius Amyand, who on December, 6,1735 performed the 1stsuccessful appendectomy during the treatment of 11 years old boy presented with right inguinal hernia .During the surgery Amyand found a pin within the appendix which was encrusted with stone theappendix was found within the inguinal hernia sac. (2) It should not be confused with the incidentalfindings of cecal appendix within the femoral hernia sac “ de Garengeot’s hernia” which is firstdescribed by Rene de Garengeot in 1731(3.4)In almost 1% of all inguinal hernias Amyand’s hernia is detected and acute appendicitis in Amyand’shernia cases accounts only for 0.1% “ 0.07-0.13”. (5)The reported mortality rate of Amyand’s hernia ranges from 5.5%- 30%.This variation occurs due to the effect of early diagnosis, giving proper treatment, preventing intraabdominal sepsis, and good postoperative care. (6) It is generally accepted that surgical treatment ofAmyand’s hernia includes both appendectomy and hernia repair. (5,6.7)However, appendectomy in the absence of an inflamed appendix and the use of mesh in cases ofappendectomy remain to be controversial.Some authors offer not to perform prophylactic appendectomy when non inflamed appendix isincidentally found in the hernial sac. (6)Others believe that appendectomy should be performed in all cases to prevent future reherniation andappendicitis. (8.9) It has been thought that it is impossible to reach sufficient number of Amyand’shernias cases to get evidence- based data due to its rarity. Therefore it is logical to revise theclassification and surgical treatment of Amyand’s hernia based on the case reports from differentinstitutions. The aim of this study is to review the experience of mesh inguinal hernia repair withoutperforming appendectomy in patients with Amyand’s hernia with healthy looking vermiform appendixwith close postoperative follow up to detect recurrence or other postoperative complications.

فتق "أمياند" هو الفتق المغبني في حالة وجود الزائده الدوديه من ضمن محتوياته سواء كانت الزائده ملتهبه أو غير ملتهبه, وتحصل هذه الحاله بواقع 1من حالات الفتق المغبني.عرض الحالات:أجريت هذه الدراسه عبر مراجعة ) 402 ( حاله من عمليات الفتق المغبني أجريت في مستشفى الشهيد أحمد أسماعيل – السليمانيه - جمهورية العراقفي الفتره من أبريل 2013 الى أبريل 2018من جميع هذه الحالات وجدت فقط ) 3( حالات من فتق "أمياند" جميعها احتوت على زائده دوديه غير ملتهبه, تم اصلاح الفتق للحالات الثلاثه عن طريقوضع شبكة )البرولين( بدون أجراء عملية رفع الزائده الدوديه.ألأستنتاج:فتق "أمياند" هي حاله نادره تمثل تحديا من ناحية اتخاذ القرار المتعلق بطريقة العلاج لكونه يرتكز على عوامل متعدده.نجد انه من المهم ان تكون للجراح معلومات كافيه عن انواع هذا الفتق وطرقه العلاجيه المتعدده.

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