Incarcerated Amyand’s hernia in a 6-week old infant repaired under spinal anesthesia

Abstract

Amyand’s hernia is characterized by the presence of the vermiform appendix in an inguinal hernia sac. It occurs in less than 1% of all inguinal hernias in children’s age. As the usual pediatric inguinal hernia, it can present in multiple ways, from uncomplicated to incarcerated and/or strangulated hernia with normal, inflamed or even perforated vermiform appendix within the hernia sac. The repair of all the infant cases we came across in literature involved herniorrhaphy with or without appendectomy and general anesthesia.

Herein, we present a case of Amyand’s hernia in an infant with concomitant patent ductus arteriosus (PDA), patent foramen ovale (PFO) and interventricular septum hypertrophy that presented with signs and symptoms suggestive of ordinary right-sided incarcerated inguinoscrotal hernia. Due to the cardiac anomaly the infant underwent spinal anesthesia for the hernia repair, thus contributing to the rarity of the case. By thorough literature review, we could not find any similar case of Amyand’s hernia incarceration in an infant operated on under spinal anesthesia. Furthermore, we discuss the surgical and anesthetic aspects of this condition in children.