Perforated appendix and periappendicular abscess within an inguinal hernia

Amyand's hernia containing appendiceal neuroma presenting as incarcerated inguinal hernia: A rare case report from Ethiopia

INTRODUCTION AND IMPORTANCE

Amyand's hernia is a rare type of inguinal hernia which involves either a normal or diseased appendix within the hernia sac. We report an extremely rare case of appendiceal neuroma, presenting as an incarcerated Amyand's hernia.

CASE PRESENTATION

A 55-year-old male patient presented in the emergency department due to a persistent right inguinal painful swelling. Clinical examination revealed a 5 cm × 3 cm firm and irreducible right groin mass. A diagnosis of an incarcerated right inguinal hernia was made, and the patient was prepared for surgery. Intraoperatively, a 5 cm × 3 cm firm mass originating from the distal part of the appendix was found in the hernia sac. An appendectomy and a modified Bassini hernia repair were done. The result of the histological examination revealed appendiceal neuroma, and no further surgical intervention was needed.

DISCUSSION

Amyand's hernia encompasses various pathological features, including a normal, inflamed, or perforated appendix, and rarely appendiceal tumors. In the literature, we found about eight cases of malignant appendiceal tumors reported. Most of the cases indicate that the treatment of Amyand's hernia containing appendiceal tumors was an appendectomy alone, while one report with adenocarcinoma required a right hemicolectomy after biopsy result. Notably, there are no documented cases of appendiceal neuromas presenting as inguinal hernias in our search of English literature using Google Scholar and PubMed search engines.

CONCLUSION

Amyand's hernia-containing appendiceal neuroma is an extremely rare entity. It is important to do histopathologic study to differentiate appendiceal neuroma from malignant tumors. In case of Amyand's hernia with appendiceal neuroma, simple appendectomy with hernia repair is adequate treatment.

Post-operative abscess in inguinal hernial sac-case report of an unusual complication of perforated acute appendicitis

Acute appendicitis is a common condition, with a lifetime risk of 7–8%. Common complications of surgical management include bleeding, bowel injury, residual abscess formation and post-operative ileus. This is a rare case of a 50-year-old male who underwent laparoscopic converted to open appendicectomy for perforated acute appendicitis, with a complication of post-operative fluid collection that extended into the right inguinal hernia sac.

Appendiceal Carcinoid Tumor within Amyand's Hernia: A Case Report and Review of the Literature

INTRODUCTION

Amyand's hernia is defined as the herniation of the whole or a part of appendix vermiformis into an inguinal hernia sac. Amyand's hernia is very rare, constituting about 1% of all inguinal hernia patients and 0.1% of all acute appendicitis patients. In one-quarter of Amyand's hernia patients, inflammatory changes are detected in appendix vermiformis. Detecting an appendiceal tumor in an Amyand's hernia sac is extremely rare, with only eight cases having been reported so far in the English literature.

CASE PRESENTATION

A 64-year-old man with an appendiceal carcinoid tumor inside an incarcerated Amyand's hernia sac. As the tumor was localized to the radix of the appendix, resection was carried out with the help of a linear-cutter stapler in a way to contain a part of the cecal wall. As the pathology examination revealed a carcinoid tumor infiltrating the periappendicular fatty tissue, right hemicolectomy was performed in a second session, in compliance with the oncological principles. No metastasis was present at the 24th month. Case reports published in the English literature regarding the Amyand's hernia with an appendiceal tumor were also analyzed in this study.

CONCLUSION

Amyand's hernia containing an appendiceal tumor is an extremely rare clinical entity. Clinical manifestations mostly mimic the incarcerated hernia and thus accurate diagnosis is made incidentally during hernia surgery. The basic oncological principles apply for the approach to tumors inside a hernia sac.

Acute appendicitis presenting as an abdominal wall abscess: A case report

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Amyand’s hernia is uncommon in females.

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The initial presentation as an abdominal wall abscess is very rare in the contemporary literature.

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An index of suspicious, early diagnosing and surgical intervention lead to favorable recovery.

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The management should follow general guidelines of appendectomy, hernia repair and dealing with the associated pathology if present.

Introduction

Amyand hernia (AH) is a rare type of hernia characterized by the presence of appendix vermiformis in the inguinal hernial sac. It is rarely reported in women.

Presentation of case

We presented a case of a 60- year old woman who was admitted initially with an abdominal wall abscess and found to have perforated appendix in the right inguinal hernia. The patient underwent standard open appendectomy and the post-operative course was uneventful.

Discussion

The initial presentation of our case as an abdominal wall abscess is rare in the contemporary literature.

Conclusions

A high index of suspicious, early diagnosis and timely surgical intervention are the keys to have favorable outcome in amyand hernia. The management should follow general guidelines of appendectomy, hernia repair and dealing with the associated pathology if present.

An Appendiceal Carcinoid Tumor within an Amyand's Hernia Mimicking an Incarcerated Inguinal Hernia

Introduction. We report the case of an appendiceal carcinoid tumor within an Amyand's hernia, presenting as an incarcerated right inguinal hernia. Presentation of Case. A 52-year-old male presented in the emergency department due to a persistent right inguinal pain. Clinical examination revealed a tender right groin mass. Laboratory tests revealed leukocytosis and an increased serum CRP. Under the diagnosis of an incarcerated right inguinal hernia, an emergency operation was taken. Intraoperatively, an inflamed appendix and a part of the cecum were found in the hernia sac. The operation was completed with an appendectomy and a modified Bassini hernia repair. Histological examination revealed a carcinoid tumor, resulting in the performance of a right hemicolectomy. Discussion. Amyand's hernia is estimated to account for 0.4% to 0.6% of all inguinal hernias. Coexistence of an Amyand's hernia and a neoplasia is quite rare. Carcinoids are the most frequent tumors found in the appendix, with the size of the primary tumor to be considered the most important prognostic factor and the basis upon which the operative plan is decided. Conclusion. A malignancy of the appendix should always be in the differential diagnosis of a right inguinal mass, in order to provide optimum surgical treatment.

Amyand's hernia: a review

BACKGROUND

The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. The aim of this systematic review was to gather information concerning its prevalence, clinical image, diagnosis, and treatment.

DATA SOURCES

The MEDLINE database was thoroughly searched using the keyword "Amyand's hernia." Additional articles were gathered and evaluated.

CONCLUSIONS

The true prevalence of Amyand's hernia seems lower than classically described. Its usual clinical image is identical to that of an incarcerated hernia, and thus it is almost impossible to diagnose preoperatively, although ultrasound and computed tomography can help. Treatment includes hernioplasty with or without appendectomy and/or mesh repair depending on the vermiform appendix's inflammation status, the patient's general condition, and other factors. Amyand's hernia generally has a good prognosis, although serious complications have been described. Surgeons should be prepared if they encounter Amyand's hernia because appropriate treatment ensures hernia repair without complications and with avoidance of recurrence.

Amyand's hernia: a review

Amyand’s hernia is defined as when the appendix is trapped within an inguinal hernia. While the incidence of this type of hernia is rare, the appendix may become incarcerated within Amyand’s hernia and lead to further complications such as strangulation and perforation. Incarceration of the appendix most commonly occurs within inguinal and femoral hernias, but may arise to a lesser extent in incisional and umbilical hernias. Incarcerated appendix has been reported in a variety of ventral abdominal and inguinal locations, yet its indistinct clinical presentation represents a diagnostic challenge. This paper reviews the literature on incarceration of the appendix within inguinal hernias and discusses current approaches to diagnosis and treatment of Amyand’s hernia and complications that may arise from incarceration of the appendix within the hernia.

Amyand's Hernia: A Case of an Unusual Inguinal Herniace

An inguinal hernia containing appendix is termed an Amyand's hernia. It is an uncommon and rare condition estimated to be found in approximately 1 % of adult inguinal hernia repairs. Depending on the extent of inflammation in the hernia sac and obstruction of hernia, clinical presentation can vary. We report a case of Amyand's hernia in a 22-year-old male who presented with history of right inguinal hernia for 6 months duration. Operation revealed hernia sac containing inflamed appendix hence appendectomy was performed.

Left inguinal appendix in an HIV patient: A case report and review of literature

INTRODUCTION

The presence of the appendix in an inguinal hernia sac is rare, with an estimated incidence of 0.51-1% of all inguinal hernias. An inguinal appendix is most commonly referred to as Amyand's hernia.

PRESENTATION OF CASE

A 59-year-old HIV positive male presented to our center with a left painful inguinal mass. The preoperative diagnosis was a left inguinal hernia. Intraoperatively, the sac was found to contain a non inflamed appendix; the appendix was reduced back to the peritoneal cavity and the patient underwent a tension free prosthetic left inguinal hernia repair.

DISCUSSION

Most cases of inguinal appendices are right-sided and are diagnosed intraoperatively; left-sided cases as we encountered are rare and most likely the result of cecal mobility. Preoperative diagnosis of the entity is difficult and most cases are diagnosed intraoperatively. A CT scan is not necessary unless other pressing differentials need to be ruled out. Most authors agree that if the appendix is not inflamed, appendectomy, concurrently with herniorrhaphy, should not be performed to avoid perioperative septic complications.

CONCLUSION

Surgical management of inguinal appendices carries a risk of septic complications. This is especially pertinent to our case, considering the immunocompromised status of our patient. The decisions in the operating room were geared toward limiting septic potential.

Amyand's hernia-a vermiform appendix presenting in an inguinal hernia: a case series

INTRODUCTION

A vermiform appendix in an inguinal hernia, inflamed or not, is known as Amyand's hernia. Here we present a case series of four men with Amyand's hernia.

CASE PRESENTATIONS

We retrospectively studied 963 Caucasian patients with inguinal hernia who were admitted to our surgical department over a 12-year period. Four patients presented with Amyand's hernia (0.4%). A 32-year-old Caucasian man had an inflamed vermiform appendix in his hernial sac (acute appendicitis), presenting as an incarcerated right groin hernia, and underwent simultaneous appendectomy and Bassini suture hernia repair. Two patients, Caucasian men aged 36 and 43 years old, had normal appendices in their sacs, which clinically appeared as non-incarcerated right groin hernias. Both underwent a plug-mesh hernia repair without appendectomy. The fourth patient, a 25-year-old Caucasian man with a large but not inflamed appendix in his sac, had a plug-mesh hernia repair with appendectomy.

CONCLUSION

A hernia surgeon may encounter unexpected intraoperative findings, such as Amyand's hernia. It is important to be prepared and apply the appropriate treatment.

Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review

AIM

To document unusual findings in appendectomy specimens.

METHODS

The clinicopathological data of 5262 patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English language studies published between 2000 and 2010 on unusual findings in appendectomy specimens.

RESULTS

Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed with tuberculous appendicitis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed.

CONCLUSION

Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

An abscess mimicking a left incarcerated groin hernia

We present the case of a 79-year-old man with an irreducible and painful left groin mass. Obtaining a detailed history of present illness and assessment of radiological findings revealed an abscess in a groin hernia sac, which was formed secondary to perforation of the descending colon. Various examinations, however, failed to reveal the cause of the bowel perforation. Percutaneous drainage improved his symptoms. He was discharged home 24 days after admission with no further sequelae. An abscess in a groin hernia sac is very rare. Although neither bowel perforation nor hernia is rare, surgeons do not sufficiently consider the possibility of an abscess in a groin hernia sac. Thus, surgeons often encounter unexpected abscesses in the groin hernia sac during operations. Our case points to the necessity of obtaining a detailed history of present illness as well as assessment of radiological findings, and presents a therapeutic option for an abscess in a groin hernia sac.

Amyand's Hernia - Case Report and Review of the Literature

Amyand's hernia is an extremely rare condition in which the appendix is positioned in the inguinal hernia sac. Acute appendicitis is much less common in this situation and few reports are found in the literature. We report a case of acute appendicitis with the tip of the appendix incarcerated outside the external ring of the right groin. A mobilized cecum and ascending colon were noticed during surgery. We conducted a review of the literature, emphasizing possible causes and suggesting a predisposing factor for the condition.

"Hernia-itis", a case report

We describe a case of an incarcerated hernia in which there was good evidence that infection was the primary aetiology. We propose the term hernia-itis to describe similar cases to facilitate identifying them in the literature.