PEDİATRİK YAŞTA AMYAND HERNİ: TEK CERRAH DENEYİMİ

Amaç Amyand herni, inguinal herni kesesinde apendix vermiformisin varlığı ile karakterize nadir görülen bir herni türüdür. Çoğunlukla, inkarsere inguinal herni ön tanısı ile ameliyat edilen hastalarda tesadüfen tanı konulur. Bu nadir patoloji hakkındaki deneyimin sunulması amaçlandı. Gereç ve Yöntem Bu çalışmada 2011-2017 tarihleri arasında tek bir çocuk cerrahı tarafından ameliyat edilen on Amyand hernili çocuk hastanın retrospektif bir analizi yapıldı. Hastaların demografik özellikleri (yaş, cinsiyet), başvuru şikayetleri, tedavi yöntemleri, histopatolojik bulguları ve postoperatif sonuçları değerlendirildi. Bulgular Amyand hernili tüm hastalar erkekti. Yaş ortalaması 12.02 aydı (17 gün-8 yaş). Hepsinde sağ inguinal herni mevcuttu. Hastaların 4’üne inkarsere inguinal herni ön tanısıyla acil cerrahi uygulandı. Geri kalan 6 hasta, elektif herni onarımı sırasında tesadüfen tanı aldı. Dokuz hastaya konvansiyonel herni onarımı yapıldı ve sadece bir hasta laparoskopi kullanılarak ameliyat edildi. Ameliyat bulguları 7 hastada normal apendiks ve 3 hastada inflame apendiksti. Apendiksi fıtık kesesine yapışık olan 3 hastanın ikisinde inflame apandisit birinde lenfoid hiperplazi saptandı. Dört hastada inguinal herni onarımı sırasında apendektomi, diğer 6 hastada apendektomi yapılmadan herni onarımı yapıldı. Hiçbir hastada tekrarlayan fıtık görülmedi. Sonuç Sağ inguinal hernisi olan hastaların ayırıcı tanısında Amyand hernisi unutulmamalıdır. Fıtık kesesine yapışan apendiksin inflamasyon durumu uygun bir tedavi kararı verebilmek için dikkatle değerlendirilmelidir.

Anahtar Kelimeler:

inguinal, amyand herni, çocuk, apendektomi

AMYAND’S HERNIA IN PEDIATRIC AGE: A SINGLE SURGEON EXPERIENCE

Objective Amyand's hernia is the presence of appendix in the hernia sac and is rarely seen. The diagnosis is mostly made incidentally during the operation performed due to the incarcerated inguinal hernia. It was aimed to present the experience about this rare pathology. Material and Method Analysis of 10 children with Amyand's hernia operated by a single pediatric surgeon between 2011 and 2017 was performed, retrospectively. Demographic features (age, gender), complaints, treatment methods, histopathological findings and postoperative results were evaluated. Results All patients were male. The average age was 12.02 months (17 days-8 years). All had a right inguinal hernia. Emergency surgery was performed in 4 of the patients with an initial diagnosis of incarcerated inguinal hernia. The remaining 6 patients were diagnosed incidentally during elective hernioplasty. While 9 patients were treated with conventional hernia repair, only one patient underwent laparoscopy. Surgical findings included 7 normal appendices ve 3 inflamed appendices. Of 3 patients with appendix adhered to the hernia sac, 2 has appendicitis and 1 has lymphoid hyperplasia. Appendectomy was performed during inguinal hernia repair in 4 patients and hernia repair was performed in 6 patients without appendectomy. Recurrent hernias were not observed in any patients. Conclusion Amyand's hernia should be kept in mind in the differential diagnosis of patients with right inguinal hernia. The inflammation status of appendix adhering to the hernia sac should be carefully evaluated for an appropriate treatment decision.

Keywords:

Inguinal, Amyand's hernia, Child, Appendectomy,

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