Case Report “Laparoscopic Management of Strangulated Left-sided Amyand’s Hernia in a Child: A Case Report”

Case Report “Laparoscopic Management of Strangulated Left-sided Amyand’s Hernia in a Child: A Case Report” | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Case Report “Laparoscopic Management of Strangulated Left-sided Amyand’s Hernia in a Child: A Case Report” Mohie El-Din Mostafa Madany This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4915935/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background/Aims Amyand’s hernia is a rare condition where the appendix is found within the sac of an inguinal hernia, and it can either be inflamed/perforated or non-inflamed in an irreducible hernia. Left-sided AH is less common than right-sided, and its management is challenging, especially in the pediatric age group. Case Presentation We present a case of an 18-month-old male child with a history of left groin hernia since birth, who presented with a sudden increase in the size of the hernia, associated with vomiting and tenderness. A laparoscopic exploration revealed entrapped loops of the intestine in the left internal ring, which was successfully reduced without any injury or complication. The contents of the hernia included the terminal ileum, the ileocecal junction, the caecum, and the appendix, which were all viable. The internal ring was repaired using prolene sutures, and the peritoneum was closed using vicryl sutures. The child had an uneventful postoperative course and was discharged on the same day of surgery. Conclusions This case highlights the importance of prompt diagnosis and appropriate surgical management in pediatric patients with AH to prevent complications and ensure optimal outcomes. Also, laparoscopic reduction and repair of an incarcerated left-sided AH is a safe and effective procedure in pediatric patients. Laparoscopic management offers several advantages over open techniques and is a suitable alternative. General Surgery Amyand’s hernia Laparoscopy Left Amyand’s hernia Incarcerated hernia Strangulated hernia Figures Figure 1 Figure 2 Introduction In Amyand's hernia (AH), the appendix is found intraoperative inside the sac of an inguinal hernia. It may be non-inflamed or inflamed and intact or ruptured. ( 1 , 2 ) Due to the patent processes vaginalis, children are three times more likely to develop it than adults ( 3 , 4 ). Though left-sided situs inversus, malrotation, or mobile caecum are less common, most documented AH cases have been observed in the right inguinal area. ( 5 – 7 ) Despite the extreme rarity of left AH, the potentially serious complications of missing the diagnosis of the incarcerated appendix necessitate its inclusion in the differential diagnosis of left inguinal painful swelling. ( 8 – 10 ) The management of AH in pediatric patients remains challenging for the surgeon. In diagnoses, it shares similar symptoms with incarcerated or strangulated hernias and acute appendicitis and is usually identified during the operation ( 11 ). However, the advent of laparoscopic repair, which has gained popularity due to its minimally invasive nature and improved visualization of the internal anatomy, has significantly improved the treatment landscape ( 12 ). In this report, we present a case of successful laparoscopic reduction of a strangulated left-sided AH in an 18-month-old child, underscoring the transformative potential of this approach. Case presentation and surgical technique An 18-month-old child with a history of left groin hernia presented to the emergency room with complaints of tenderness and a sudden increase in hernia size, accompanied by greenish vomiting. Physical examination revealed a tense and tender hernia. Laboratory tests were conducted along with an abdominal ultrasound. Under general anesthesia, a laparoscopic exploration was performed with meticulous insertion of ports to facilitate a comprehensive view of the abdominal cavity. A 5-mm port for the 5 mm 30° scope was carefully inserted into the umbilicus. During exploration, intestinal loops were caught in the left internal ring (video 1). To finish the surgical process, two more 5 mm ports were strategically placed in the midclavicular lines. The right port was positioned slightly below the umbilical port, and the left port was positioned at the same level as the umbilicus, ensuring an optimal surgical setup. Our institute policy is to reserve the 3-mm ports/ instruments for infants up to 12 months, as these instruments are somewhat fragile, further emphasizing our commitment to our low-resource settings. Intestinal loops caught in the left internal ring were discovered and reduced, with careful maneuvers to avoid injury. The appendix, cecum, ileocecal junction, and terminal ileum were viable, with the appendix initially appearing cyanosed (Fig. 1 ) but later recovering its normal color (Fig. 2 ). No malrotation of the colon was observed, but a mobile cecum and oedematous internal ring were noted. The sac was separated from the peritoneal cavity, and the ileopubic tract was repaired with continuous sutures as shown in video link: “ https://player.vimeo.com/video/866994353 ”. A 3/0 prolene suture was used to repair the inguinal hernia defect and narrow the internal ring, with careful dissection to avoid injury to vital structures. The internal ring was tightened so that it could comfortably pass the tip of the 5-mm instrument (about 3-mm) beside the vas and vessels, which should be carefully dissected and protected from injury. Following the procedure, the child had a straightforward postoperative course and was discharged after 6 hours of surgery. Subsequent follow-ups at one, three, and seven weeks showed no complications. Discussion This case describes the presentation and management of an 18-month-old male child with a strangulated left AH. AH is more commonly observed in males than females. This predominance is linked to the higher occurrence of a patent processus vaginalis in boys. It can affect all age groups, showing a bimodal age distribution in infants and the elderly since the size of the internal inguinal ring varies with age, being relatively large at birth, narrowing during midlife, and enlarging again with advancing age ( 11 , 13 ). In their retrospective analysis, Almetaher et al. (2020) presented 12 pediatric patients aged between 15 days and five years with right AH and operated in their tertiary referral hospital. Ten out of the 12 children were boys. ( 4 ) In the 20-year systematic review conducted by Manatakis et al. (2021), the left AH has been reported in about 42 (9.5%) of the 442 cases (children and adults). Children accounted for 42.5% of cases (18 cases). After that review, we identified another two cases in children, one in a 2-month-old male infant and the other in a 15-month-old male child. ( 11 , 14 , 15 ) The child in our study presented to the emergency room with tenderness and a sudden increase in hernia size, along with greenish vomiting, indicating potential bowel obstruction. Physical examination revealed a tense and tender hernia, prompting further evaluation with laboratory tests and an abdominal ultrasound. Diagnosing AH preoperatively can pose challenges, often presenting as incarcerated inguinal or inguinoscrotal swellings. Surgeons should be vigilant about this rare condition, especially when encountering an irreducible hernia without typical signs of intestinal obstruction. Clinical examinations of AH can reveal incarceration without the symptoms and signs of intestinal obstruction as mentioned by Almetaher et al. (2020). Symptoms like fever, vomiting, and abdominal distention may vary depending on the condition of the appendix, whether inflamed or perforated. The possible conditions that may be mistaken for AH are broad and may comprise irreducible, incarcerated, or strangulated hernia, acute appendicitis, urological emergencies, and cutaneous complications. Imaging techniques such as inguinoscrotal ultrasonography and CT scan are crucial for accurate prediction and diagnosis. ( 4 , 16 ) The appendix within the hernia sac is usually discovered incidentally during planned hernia surgeries. However, not all cases of the appendix moving into the inguinal canal result in acute appendicitis, and the lower likelihood of the appendix becoming trapped and inflamed in an inguinal hernia may be explained by the inguinal ring being wider and more flexible than the femoral ring. ( 16 – 18 ) According to the classification of AH presented by Losanoff and Basson ( Table 1 ), and as our case did not have any manifestation of peritonitis or an abscess, we opted for laparoscopic management. Of course, if the diagnosis is unclear, laparoscopy is helpful ( 19 , 20 ). Table 1 Types of Amyand's hernia and their management Type of hernia 1 2 3 4 Salient features Normal appendix Acute appendicitis localized in the sac Acute appendicitis, peritonitis Acute appendicitis, other abdominal pathology Surgical Management Reduction or appendectomy (depending on age), mesh hernioplasty Appendectomy through hernia, endogenous repair Appendectomy through laparotomy, endogenous repair Appendectomy, diagnostic workup and other procedures as appropriate In our study , meticulous port insertion allowed for a comprehensive view of the abdominal cavity. Intestinal loops caught in the left internal ring were identified and reduced using careful maneuvers to avoid injury to the bowel. In our case, we discovered a mobile caecum as the etiology. That is in agreement with Joshi et al. (2022) who reported that there was no situs inversus or intestinal malrotation observed in their patient and concluded that a mobile caecum was the likely cause for the left-sided nature of the hernia in their case. ( 15 ) For type 1 hernias, considering the patient's age and lifelong risk of appendicitis is crucial before deciding on appendix removal. Routine appendectomy is not universally recommended, as even elective procedures raise the risk of complications. The choice between mesh - rarely used in infants or children- or endogenous tissue repair for type 2 hernias depends on specific surgical circumstances. ( 19 , 20 ) The approach to dealing with a normal-looking appendix in pediatric patients with AH remains a topic of debate. While it is generally agreed upon that appendectomy should be performed in cases of AH with appendicitis, there are controversies regarding AH cases where the appendix appears normal ( 4 , 21 – 23 ). Many authors argue that a normally looking appendix incidentally discovered during surgery, without any signs of inflammation, should not be removed, and prophylactic appendectomy is unnecessary ( 4 , 24 , 25 ). They suggest that unnecessary appendectomy may increase operative risks, potentially lead to the dissemination of infection, and weaken tissues at the incision site, possibly resulting in recurrence. Additionally, the appendix may have future utility in other surgical procedures, such as urinary diversion. This perspective is supported by a case series study, where keeping the normally looking appendix and repairing AH were performed in 11 patients without postoperative complications or recurrences. ( 4 ) On the other hand, some authors advocate for appendectomy in all AH patients. They argue that the high likelihood of appendix herniating in young patients, leading to recurrence, may predispose them to later appendicitis ( 4 , 21 – 23 ). Luciana et al. (2019) reported right-side AH in a 2-year-old male who came to the emergency department with a history of irreducible lump along with right scrotal tenderness 6 hours before admission and progressively increased. There is no specific sign of obstruction, dehydration, or infection. In contrast to our case, this patient did an open repair of hernia as diagnostic and therapeutic; identification of the appendix was a non-inflamed appendix inside the right scrotum, with no sign of incarceration, strangulation, or perforation. No complications were reported until two months postoperative. They choose to perform appendectomy for this case with a satisfying outcome. ( 3 ) Furthermore. in cases of AH with acute appendicitis, recurrent hernial cases, and in cases of left AH to prevent further diagnostic delays in cases of acute appendicitis ( 4 , 7 , 26 , 27 ), and those cases where adhesion of the appendix with hernial sac is encountered, wherein the vascularity of the appendix is compromised, we believe that the removal of the appendix is justified. Otherwise, if the appendix can be readily reduced without compromising its blood supply, a preventive appendectomy is not necessary ( 1 ). In our case of left AH, we did not remove the appendix because it was non-inflamed, and its blood supply was not compromised. A laparotomy might be required in a few instances with clinical signs and symptoms of a suspected severe strangulated inguinal hernia. However, the inguinal approach is generally sufficient to treat most cases with AH ( 7 , 26 ). De Almeida et al. ( 27 ) reported a 7-month-old infant with strangulated AH, necessitating a laparotomy. During the procedure, ischemic necrosis of the caecum, terminal ileum, and appendix was discovered, requiring resection and ileocolic anastomosis. In a similar vein, Singh et al. reported a 1.5-year-old male child who suffered from strangulation and had primary repair for a caecal perforation. ( 28 ) Although the open herniotomy is a well-established technique for repairing inguinal hernias in pediatric patients, laparoscopic repair is becoming increasingly popular due to its advantages , including reduced postoperative pain, shorter hospital stays, and earlier return to daily activities. We opted for laparoscopic management in our case as w e believe that laparoscopy presents a multifaceted advantage over open techniques. As a diagnostic tool, it provides unparalleled precision, particularly in discerning the complex pathology of left-sided AH. It aids in identifying anatomical anomalies such as situs inversus totalis, malrotation, and mobile caecum, ensuring treatment planning. Moreover, it minimizes the risk of overlooking an inflamed appendix. By allowing for meticulous assessment and reduction of herniated contents without undue traction, it facilitates the safe evaluation of the strangulated appendix and surrounding viscera. Additionally, laparoscopic appendicectomy can be seamlessly integrated into the repair process, reducing contamination risk, and enabling efficient management of left-sided AH. Various techniques have been described for laparoscopic inguinal hernia repair in pediatric patients, including the closure of the internal ring, the division of the hernia sac, and the use of sutures, staples, or mesh to secure the repair. ( 29 , 30 ) In our current case, we chose to disconnect the hernia sac and then tighten the internal ring using continuous 3/0 prolene sutures between the transversus abdominis muscular arch and the iliopubic tract, respecting the contents of the internal ring. Continuous sutures have been demonstrated to lower the recurrence rate in laparoscopic hernia repair compared to interrupted sutures. ( 31 ) In our case, the entrapped intestine was reduced through gentle manipulations from the inside, combined with gentle external pressure on the swelling by the surgeon's and assistant's fingers. This method was found to be safe and effective for reducing incarcerated inguinal hernias in children. One potential complication of laparoscopic inguinal hernia repair is injury to the testicular vessels or vas deferens, which can result in testicular atrophy or infertility ( 32 ). In this current case, careful attention was paid to protect the vas and gonadal vessels during the disconnection of the sac from the peritoneal cavity. In our case, the absence of malrotation of the colon but the presence of a mobile cecum and oedematous internal ring were noted during the procedure. Repairing of the ileopubic tract with continuous sutures and narrowing of the internal ring was performed to prevent hernia recurrence. Careful dissection protected vital structures such as the vas and vessels. Following the successful surgical intervention, the child had a straightforward postoperative course and was discharged after 6 hours of surgery. Subsequent follow-up appointments showed no complications, indicating a favorable outcome of the procedure . Several studies have reported comparable outcomes between open and laparoscopic repair regarding recurrence rates, complication rates, and postoperative pain. However, laparoscopic repair may offer advantages such as shorter hospital stays, earlier return to normal activities, and improved cosmesis. ( 33 ) In conclusion , this case highlights the importance of prompt diagnosis and appropriate surgical management in pediatric patients with groin hernias to prevent complications and ensure optimal outcomes. Also, laparoscopic reduction and repair of an incarcerated left-sided inguinal hernia is a safe and effective procedure in pediatric patients. It offers several advantages over open techniques and is a suitable alternative for the repair of pediatric inguinal hernias particularly left-side AH. Declarations • Ethics approval and consent to participate Not applicable. • Consent for publication Consent for publication was obtained from the legal guardian. • Availability of data and materials Data is provided within the manuscript or supplementary information files. Complete nonedited video recording of the procedure is available on request. • Competing interests Not applicable. • Funding No funding. • Authors' contributions The study has a single author. • Patient Perspective Not applicable • Disclosures I have nothing to disclose. References Jalil S, Azhar M, Malkani I, Harb ElKadi TT, Ali AE, Wahid FN (2023) Amyand’s hernia in children. J Pediatr Surg Case Rep 89:102560 Klyuev S, Azizoğlu M (2023) Challenges in strategies for Amyand hernia in children: literature review with clinical illustrations. Ann Pediatr Surg 19(1):36 Luciana L, Antara GER, Bharatha MDY Pediatric amyand hernia: case report in Sanjiwani Gianyar Hospital Bali-Indonesia. Intisari Sains Medis [Internet]. 2019 Aug 1 [cited 2024 May 1];10(2). https://www2.isainsmedis.id/index.php/ism/article/view/511 Almetaher HA, Mansour MA, Arafa MA (2020) Management of Amyand’s hernia in children: should appendectomy be mandatory or not? Ann Pediatr Surg. ;16(1) Michalinos A, Moris D, Vernadakis S (2014) Amyand’s hernia: a review. Am J Surg 207(6):989–995 Sandhu A, Liaqat N, Nayyar SI, Faryal R, Shafique S (2014) Amyand†™ s Hernia with Perforated Appendix in a Neonate. APSP J Case Rep. ;5(3) Khan R, Wahab S, Ghani I (2011) Left-sided strangulated Amyand’s hernia presenting as testicular torsion in an infant. 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Hernia J Hernias Abdom Wall Surg 11(1):31–35 Cankorkmaz L, Ozer H, Guney C, Atalar MH, Arslan MS, Koyluoglu G (2010) Amyand’s hernia in the children: a single center experience. Surgery 147(1):140–143 Tubbs SR (2014) Amyand’s hernia: a review. Med Sci Monit 20:140–146 de Almeida RQ, Zara A, Ferreira D, Schulz F, Waisberg J (2021) Incarcerated Amyand hernia with necrosis of the appendix and cecum. J Pediatr Surg Case Rep 69:101863 Singh K, Singh RR, Kaur S (2011) Amyand’s hernia. J Indian Assoc Pediatr Surg 16(4):171–172 Li B, Shi S, Qin C, Yu J, Gong D, Nie X et al Internal Ring Defect Closure Technique in Laparoscopic Mesh Hernioplasty for Indirect Inguinal Hernia. Front Surg [Internet]. 2022 Feb 7 [cited 2024 May 8];9. https://www.frontiersin.org/articles/ 10.3389/fsurg.2022.794420 Ross SW, Oommen B, Kim M, Walters AL, Augenstein VA, Heniford BT (2015) Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life. Surg Endosc 29(7):1686–1693 Madsen LJ, Oma E, Jorgensen LN, Jensen KK (2020) Mesh versus suture in elective repair of umbilical hernia: systematic review and meta-analysis. BJS Open 4(3):369–379 Berndsen MR, Gudbjartsson T, Berndsen FH (2019) [Inguinal hernia - review]. Laeknabladid 105(9):385–391 Haladu N, Alabi A, Brazzelli M, Imamura M, Ahmed I, Ramsay G et al (2022) Open versus laparoscopic repair of inguinal hernia: an overview of systematic reviews of randomised controlled trials. Surg Endosc 36(7):4685–4700 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4915935","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":340455606,"identity":"34a3289c-4952-4d99-9caa-08438268f98a","order_by":0,"name":"Mohie El-Din Mostafa Madany","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-9930-6779","institution":"Aswan University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mohie","middleName":"El-Din Mostafa","lastName":"Madany","suffix":""}],"badges":[],"createdAt":"2024-08-14 20:46:02","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-4915935/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4915935/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62628697,"identity":"4f7e0125-080d-47c5-aebb-7ddf1200c1a3","added_by":"auto","created_at":"2024-08-16 15:43:39","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62878,"visible":true,"origin":"","legend":"\u003cp\u003eCyanosed appendix on immediate reduction of the contents of left Amyand’s hernia.\u003c/p\u003e","description":"","filename":"1m.jpg.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4915935/v1/2198e3e04ac21b6df34f0037.jpeg"},{"id":62628698,"identity":"bd0cb51b-531b-4bda-b774-b1878576147e","added_by":"auto","created_at":"2024-08-16 15:43:39","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":80997,"visible":true,"origin":"","legend":"\u003cp\u003eThe appendix recovered its normal color.\u003c/p\u003e","description":"","filename":"2m.jpg.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4915935/v1/930381c47968e3f6745d4bbf.jpeg"},{"id":62629565,"identity":"10ab72ea-5ab7-416d-a93a-06e61db4f5d4","added_by":"auto","created_at":"2024-08-16 15:51:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":963367,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4915935/v1/473db02a-a217-45a6-8678-a05642dda664.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eCase Report\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e“Laparoscopic Management of Strangulated Left-sided Amyand’s Hernia in a Child: A Case Report”\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn Amyand's hernia (AH), the appendix is found intraoperative inside the sac of an inguinal hernia. It may be non-inflamed or inflamed and intact or ruptured. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDue to the patent processes vaginalis, children are three times more likely to develop it than adults (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Though left-sided situs inversus, malrotation, or mobile caecum are less common, most documented AH cases have been observed in the right inguinal area. (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDespite the extreme rarity of left AH, the potentially serious complications of missing the diagnosis of the incarcerated appendix necessitate its inclusion in the differential diagnosis of left inguinal painful swelling. (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe management of AH in pediatric patients remains challenging for the surgeon. In diagnoses, it shares similar symptoms with incarcerated or strangulated hernias and acute appendicitis and is usually identified during the operation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, the advent of laparoscopic repair, which has gained popularity due to its minimally invasive nature and improved visualization of the internal anatomy, has significantly improved the treatment landscape (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). \u003cem\u003eIn this report, we present a case of successful laparoscopic reduction of a strangulated left-sided AH in an 18-month-old child, underscoring the transformative potential of this approach.\u003c/em\u003e\u003c/p\u003e"},{"header":"Case presentation and surgical technique","content":"\u003cp\u003eAn 18-month-old child with a history of left groin hernia presented to the emergency room with complaints of tenderness and a sudden increase in hernia size, accompanied by greenish vomiting. Physical examination revealed a tense and tender hernia. Laboratory tests were conducted along with an abdominal ultrasound.\u003c/p\u003e \u003cp\u003eUnder general anesthesia, a laparoscopic exploration was performed with meticulous insertion of ports to facilitate a comprehensive view of the abdominal cavity. A 5-mm port for the 5 mm 30\u0026deg; scope was carefully inserted into the umbilicus. During exploration, intestinal loops were caught in the left internal ring (video 1). To finish the surgical process, two more 5 mm ports were strategically placed in the midclavicular lines. The right port was positioned slightly below the umbilical port, and the left port was positioned at the same level as the umbilicus, ensuring an optimal surgical setup. Our institute policy is to reserve the 3-mm ports/ instruments for infants up to 12 months, as these instruments are somewhat fragile, further emphasizing our commitment to our low-resource settings.\u003c/p\u003e \u003cp\u003eIntestinal loops caught in the left internal ring were discovered and reduced, with careful maneuvers to avoid injury. The appendix, cecum, ileocecal junction, and terminal ileum were viable, with the appendix initially appearing cyanosed (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e) but later recovering its normal color (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNo malrotation of the colon was observed, but a mobile cecum and oedematous internal ring were noted. The sac was separated from the peritoneal cavity, and the ileopubic tract was repaired with continuous sutures as shown in video link: \u0026ldquo;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://player.vimeo.com/video/866994353\u003c/span\u003e\u003cspan address=\"https://player.vimeo.com/video/866994353\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u0026rdquo;. A 3/0 prolene suture was used to repair the inguinal hernia defect and narrow the internal ring, with careful dissection to avoid injury to vital structures. The internal ring was tightened so that it could comfortably pass the tip of the 5-mm instrument (about 3-mm) beside the vas and vessels, which should be carefully dissected and protected from injury.\u003c/p\u003e \u003cp\u003eFollowing the procedure, the child had a straightforward postoperative course and was discharged after 6 hours of surgery. Subsequent follow-ups at one, three, and seven weeks showed no complications.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cb\u003eThis case describes the presentation and management of an 18-month-old male child with a strangulated left AH.\u003c/b\u003e AH is more commonly observed in males than females. This predominance is linked to the higher occurrence of a patent processus vaginalis in boys. It can affect all age groups, showing a bimodal age distribution in infants and the elderly since the size of the internal inguinal ring varies with age, being relatively large at birth, narrowing during midlife, and enlarging again with advancing age (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In their retrospective analysis, Almetaher et al. (2020) presented 12 pediatric patients aged between 15 days and five years with right AH and operated in their tertiary referral hospital. Ten out of the 12 children were boys. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn the 20-year systematic review conducted by Manatakis et al. (2021), the left AH has been reported in about 42 (9.5%) of the 442 cases (children and adults). Children accounted for 42.5% of cases (18 cases). After that review, we identified another two cases in children, one in a 2-month-old male infant and the other in a 15-month-old male child. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe child in our study presented to the emergency room with tenderness and a sudden increase in hernia size, along with greenish vomiting, indicating potential bowel obstruction. Physical examination revealed a tense and tender hernia, prompting further evaluation with laboratory tests and an abdominal ultrasound.\u003c/b\u003e Diagnosing AH preoperatively can pose challenges, often presenting as incarcerated inguinal or inguinoscrotal swellings. Surgeons should be vigilant about this rare condition, especially when encountering an irreducible hernia without typical signs of intestinal obstruction. Clinical examinations of AH can reveal incarceration without the symptoms and signs of intestinal obstruction as mentioned by Almetaher et al. (2020). Symptoms like fever, vomiting, and abdominal distention may vary depending on the condition of the appendix, whether inflamed or perforated. The possible conditions that may be mistaken for AH are broad and may comprise irreducible, incarcerated, or strangulated hernia, acute appendicitis, urological emergencies, and cutaneous complications. Imaging techniques such as inguinoscrotal ultrasonography and CT scan are crucial for accurate prediction and diagnosis. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe appendix within the hernia sac is usually discovered incidentally during planned hernia surgeries. However, not all cases of the appendix moving into the inguinal canal result in acute appendicitis, and the lower likelihood of the appendix becoming trapped and inflamed in an inguinal hernia may be explained by the inguinal ring being wider and more flexible than the femoral ring. (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003eAccording to the classification of AH presented by Losanoff and Basson (\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e), and as our case did not have any manifestation of peritonitis or an abscess, we opted for laparoscopic management.\u003c/b\u003e Of course, if the diagnosis is unclear, laparoscopy is helpful (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTypes of Amyand's hernia and their management\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of hernia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSalient features\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal appendix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcute appendicitis localized in the sac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAcute appendicitis, peritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAcute appendicitis, other abdominal pathology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduction or appendectomy (depending on age), mesh hernioplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAppendectomy through hernia, endogenous repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAppendectomy through laparotomy, endogenous repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAppendectomy, diagnostic workup and other procedures as appropriate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eIn our study\u003c/b\u003e, \u003cb\u003emeticulous port insertion allowed for a comprehensive view of the abdominal cavity. Intestinal loops caught in the left internal ring were identified and reduced using careful maneuvers to avoid injury to the bowel. In our case, we discovered a mobile caecum as the etiology.\u003c/b\u003e That is in agreement with Joshi et al. (2022) who reported that there was no situs inversus or intestinal malrotation observed in their patient and concluded that a mobile caecum was the likely cause for the left-sided nature of the hernia in their case. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFor type 1 hernias, considering the patient's age and lifelong risk of appendicitis is crucial before deciding on appendix removal. Routine appendectomy is not universally recommended, as even elective procedures raise the risk of complications. The choice between mesh - rarely used in infants or children- or endogenous tissue repair for type 2 hernias depends on specific surgical circumstances. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe approach to dealing with a normal-looking appendix in pediatric patients with AH remains a topic of debate. While it is generally agreed upon that appendectomy should be performed in cases of AH with appendicitis, there are controversies regarding AH cases where the appendix appears normal (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). \u003cb\u003eMany authors argue that a normally looking appendix incidentally discovered during surgery, without any signs of inflammation, should not be removed, and prophylactic appendectomy is unnecessary\u003c/b\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). They suggest that unnecessary appendectomy may increase operative risks, potentially lead to the dissemination of infection, and weaken tissues at the incision site, possibly resulting in recurrence. Additionally, the appendix may have future utility in other surgical procedures, such as urinary diversion. This perspective is supported by a case series study, where keeping the normally looking appendix and repairing AH were performed in 11 patients without postoperative complications or recurrences. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOn the other hand, some authors advocate for appendectomy in all AH patients. They argue that the high likelihood of appendix herniating in young patients, leading to recurrence, may predispose them to later appendicitis (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Luciana et al. (2019) reported right-side AH in a 2-year-old male who came to the emergency department with a history of irreducible lump along with right scrotal tenderness 6 hours before admission and progressively increased. There is no specific sign of obstruction, dehydration, or infection. In contrast to our case, this patient did an open repair of hernia as diagnostic and therapeutic; identification of the appendix was a non-inflamed appendix inside the right scrotum, with no sign of incarceration, strangulation, or perforation. No complications were reported until two months postoperative. They choose to perform appendectomy for this case with a satisfying outcome. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFurthermore. in cases of AH with acute appendicitis, recurrent hernial cases, and in cases of left AH to prevent further diagnostic delays in cases of acute appendicitis (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), and those cases where adhesion of the appendix with hernial sac is encountered, wherein the vascularity of the appendix is compromised, we believe that the removal of the appendix is justified. Otherwise, if the appendix can be readily reduced without compromising its blood supply, a preventive appendectomy is not necessary (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). \u003cb\u003eIn our case of left AH, we did not remove the appendix because it was non-inflamed, and its blood supply was not compromised.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eA laparotomy might be required in a few instances\u003c/b\u003e with clinical signs and symptoms of a suspected severe strangulated inguinal hernia. However, the inguinal approach is generally sufficient to treat most cases with AH (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). De Almeida et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) reported a 7-month-old infant with strangulated AH, necessitating a laparotomy. During the procedure, ischemic necrosis of the caecum, terminal ileum, and appendix was discovered, requiring resection and ileocolic anastomosis. In a similar vein, Singh et al. reported a 1.5-year-old male child who suffered from strangulation and had primary repair for a caecal perforation. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAlthough the \u003cb\u003eopen herniotomy\u003c/b\u003e is a well-established technique for repairing inguinal hernias in pediatric patients, \u003cb\u003elaparoscopic repair is becoming increasingly popular due to its advantages\u003c/b\u003e, including reduced postoperative pain, shorter hospital stays, and earlier return to daily activities. \u003cem\u003eWe opted for laparoscopic management in our case as w\u003c/em\u003ee believe that laparoscopy presents a multifaceted advantage over open techniques. As a diagnostic tool, it provides unparalleled precision, particularly in discerning the complex pathology of left-sided AH. It aids in identifying anatomical anomalies such as situs inversus totalis, malrotation, and mobile caecum, ensuring treatment planning. Moreover, it minimizes the risk of overlooking an inflamed appendix. By allowing for meticulous assessment and reduction of herniated contents without undue traction, it facilitates the safe evaluation of the strangulated appendix and surrounding viscera. Additionally, laparoscopic appendicectomy can be seamlessly integrated into the repair process, reducing contamination risk, and enabling efficient management of left-sided AH. Various techniques have been described for laparoscopic inguinal hernia repair in pediatric patients, including the closure of the internal ring, the division of the hernia sac, and the use of sutures, staples, or mesh to secure the repair. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn our current case, we chose to disconnect the hernia sac and then tighten the internal ring using continuous 3/0 prolene sutures between the transversus abdominis muscular arch and the iliopubic tract, respecting the contents of the internal ring.\u003c/b\u003e Continuous sutures have been demonstrated to lower the recurrence rate in laparoscopic hernia repair compared to interrupted sutures. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn our case, the entrapped intestine was reduced through gentle manipulations from the inside, combined with gentle external pressure on the swelling by the surgeon's and assistant's fingers.\u003c/b\u003e This method was found to be safe and effective for reducing incarcerated inguinal hernias in children. One potential complication of laparoscopic inguinal hernia repair is injury to the testicular vessels or vas deferens, which can result in testicular atrophy or infertility (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). \u003cb\u003eIn this current case, careful attention was paid to protect the vas and gonadal vessels during the disconnection of the sac from the peritoneal cavity.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn our case, the absence of malrotation of the colon but the presence of a mobile cecum and oedematous internal ring were noted during the procedure.\u003c/b\u003e Repairing of the ileopubic tract with continuous sutures and narrowing of the internal ring was performed \u003cb\u003eto prevent hernia recurrence. Careful dissection protected vital structures such as the vas and vessels. Following the successful surgical intervention, the child had a straightforward postoperative course and was discharged after 6 hours of surgery. Subsequent follow-up appointments showed no complications, indicating a favorable outcome of the procedure\u003c/b\u003e. Several studies have reported comparable outcomes between open and laparoscopic repair regarding recurrence rates, complication rates, and postoperative pain. However, laparoscopic repair may offer advantages such as shorter hospital stays, earlier return to normal activities, and improved cosmesis. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cem\u003eIn conclusion\u003c/em\u003e, this case highlights the importance of prompt diagnosis and appropriate surgical management in pediatric patients with groin hernias to prevent complications and ensure optimal outcomes. Also, laparoscopic reduction and repair of an incarcerated left-sided inguinal hernia is a safe and effective procedure in pediatric patients. It offers several advantages over open techniques and is a suitable alternative for the repair of pediatric inguinal hernias particularly left-side AH.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003e\u0026bull; Ethics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026bull; Consent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication was obtained from the legal guardian.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026bull; Availability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files. Complete nonedited video recording of the procedure is available on request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026bull; Competing interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026bull; Funding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo funding.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026bull; Authors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study has a single author.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026bull;\u0026nbsp;\u003c/em\u003ePatient Perspective\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026bull;\u0026nbsp;\u003c/em\u003e\u003cem\u003eDisclosures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eI have nothing to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cbr\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJalil S, Azhar M, Malkani I, Harb ElKadi TT, Ali AE, Wahid FN (2023) Amyand\u0026rsquo;s hernia in children. J Pediatr Surg Case Rep 89:102560\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlyuev S, Azizoğlu M (2023) Challenges in strategies for Amyand hernia in children: literature review with clinical illustrations. Ann Pediatr Surg 19(1):36\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuciana L, Antara GER, Bharatha MDY Pediatric amyand hernia: case report in Sanjiwani Gianyar Hospital Bali-Indonesia. Intisari Sains Medis [Internet]. 2019 Aug 1 [cited 2024 May 1];10(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www2.isainsmedis.id/index.php/ism/article/view/511\u003c/span\u003e\u003cspan address=\"https://www2.isainsmedis.id/index.php/ism/article/view/511\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmetaher HA, Mansour MA, Arafa MA (2020) Management of Amyand\u0026rsquo;s hernia in children: should appendectomy be mandatory or not? Ann Pediatr Surg. ;16(1)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMichalinos A, Moris D, Vernadakis S (2014) Amyand\u0026rsquo;s hernia: a review. 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Surg Endosc 36(7):4685\u0026ndash;4700\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Aswan University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Amyand’s hernia, Laparoscopy, Left Amyand’s hernia, Incarcerated hernia, Strangulated hernia","lastPublishedDoi":"10.21203/rs.3.rs-4915935/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4915935/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground/Aims\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAmyand\u0026rsquo;s hernia is a rare condition where the appendix is found within the sac of an inguinal hernia, and it can either be inflamed/perforated or non-inflamed in an irreducible hernia. Left-sided AH is less common than right-sided, and its management is challenging, especially in the pediatric age group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCase Presentation\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe present a case of an 18-month-old male child with a history of left groin hernia since birth, who presented with a sudden increase in the size of the hernia, associated with vomiting and tenderness. A laparoscopic exploration revealed entrapped loops of the intestine in the left internal ring, which was successfully reduced without any injury or complication. The contents of the hernia included the terminal ileum, the ileocecal junction, the caecum, and the appendix, which were all viable. The internal ring was repaired using prolene sutures, and the peritoneum was closed using vicryl sutures. The child had an uneventful postoperative course and was discharged on the same day of surgery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis case highlights the importance of prompt diagnosis and appropriate surgical management in pediatric patients with AH to prevent complications and ensure optimal outcomes. Also, laparoscopic reduction and repair of an incarcerated left-sided AH is a safe and effective procedure in pediatric patients. Laparoscopic management offers several advantages over open techniques and is a suitable alternative.\u003c/p\u003e","manuscriptTitle":"Case Report\n“Laparoscopic Management of Strangulated Left-sided Amyand’s Hernia in a Child: A Case Report”","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-16 15:43:34","doi":"10.21203/rs.3.rs-4915935/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5131a9d3-bcfa-41fa-9f0e-395990fa5b4e","owner":[],"postedDate":"August 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":36072432,"name":"General Surgery"}],"tags":[],"updatedAt":"2024-08-16T15:43:34+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-16 15:43:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4915935","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4915935","identity":"rs-4915935","version":["v1"]},"buildId":"re_ckhLnmML6MCF96OHNJ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}