Amyand's hernia: a case series with critics of role of appendectomy

Controversies Regarding Mesh Utilisation and the Attitude towards the Appendix in Amyand's Hernia-A Systematic Review

Inguinal hernia containing the vermiform appendix is a rare entity. It is more common in children than in adults. It can be discovered incidentally during the surgical intervention performed for the cure of the inguinal hernia or when the appendix shows inflammatory changes, a situation that can lead to diagnostic confusion with a number of other diseases. Imaging can guide the diagnosis, which often comes as an intraoperative surprise. The therapeutic approach is controversial both in terms of whether or not to perform an appendectomy in the case of an appendix without inflammatory changes and especially in terms of using a mesh during the hernia repair process. Since the pathology is not very frequent, there are no standardized stages in terms of surgical ethics that can guarantee good surgical practice. The study aimed to carry out a review of the specialized literature to obtain some conclusions or trends regarding the management of this pathology. The low frequency of this type of hernia did not allow the consultation of large-scale studies or extensive reviews focusing on case reports or case series communications. The obtained results were statistically analyzed and integrated in relation to the surgical attitude depending on the particularities of the condition.

Left-Sided Amyand's Hernia: A Rare Variant of Inguinal Hernia

Inguinal hernia is the most commonly diagnosed hernia, with approximately one out of every three males eventually being diagnosed with an inguinal hernia. Amyand's hernia is a subtype of an inguinal hernia that occurs when the appendix is located within the hernia sac. It is an uncommon condition that is usually discovered as an incidental finding in less than 1% of all patients with inguinal hernia. The management options for this condition will vary depending on the presence or absence of appendicitis. This case report highlights a rare occurrence where a patient with a left-sided scrotal swelling was found to have a left-sided Amyand's hernia that was eventually managed without complications.

Appendiceal Carcinoid Tumor Contained in a Large Inguinal Hernia: A Case Report

We report the first case of a clinically diagnosed incidental appendiceal carcinoid tumor contained in an incarcerated inguinal hernia without inflammation of the appendix. A 67-year-old white man underwent elective open repair of an incarcerated right inguinal hernia containing small bowel, cecum, appendix, and ascending colon. He was found to have a grossly abnormal mass at the tip of his appendix. Appendectomy was performed, and histopathologic analysis confirmed the presence and adequate resection of a neuroendocrine tumor. It is important for general surgeons to be aware that unusual presentations of appendiceal tumors may not be associated with appendiceal inflammation or related symptoms.

Two Rare Cases of Appendicitis: Amyand's Hernia and De Garengeot's Hernia

An Amyand's hernia is an inguinal hernia that contains vermiform appendix. De Garengeot's hernias are similar; however, in this case the appendix is within a femoral hernia. Both types of hernia are rare, and those hernias associated with appendicitis, perforation, or abscess are even scarcer presentations. The treatment of Amyand's hernia and De Garengeot's hernia is not standardized. Generally, hernia repair is performed but disagreement remains regarding the use of mesh and performing appendectomy. This case series describes two individuals with appendicitis presenting to one emergency department within a 24-hour time frame. One case is of a patient with Amyand's hernia and another case is a patient with De Garengeot's hernia with an adjacent abscess. Both individuals were managed with appendectomy and hernia repair without the use of mesh.

Mesh Inguinal Hernia Repair and Appendectomy in the Treatment of Amyand's Hernia with Non-Inflamed Appendices

Amyand's hernia is defined as protrusion of the vermiform appendix in an inguinal hernia sac. It is a rare entity with variable clinical presentation from normal vermiform appendix to abscess formation due to perforation of acute appendicitis. Although surgical treatment includes appendectomy and hernia repair, appendectomy in the absence of an inflamed appendix and use of a mesh in cases of appendectomy remain to be controversial. The aim of this study was to review the experience of mesh inguinal hernia repair plus appendectomy performed for Amyand's hernia with noninflamed appendices. There were five male patients with a mean age of 42.4 ± 16.1 years in this retrospective study in which Amyand's hernia was treated with mesh inguinal hernia repair plus appendectomy for noninflamed appendices. Patients with acute appendicitis and perforated vermiform appendix were excluded. There were four right sided and one bilateral inguinal hernia. Postoperative courses were uneventful. During the follow-up period (14.0 ± 7.7 months), there was no inguinal hernia recurrence. Mesh inguinal hernia repair with appendectomy can be performed for Amyand's hernia in the absence of acute appendicitis. However, presence of fibrous connections between the vermiform appendix and the surrounding hernia sac may be regarded as a parameter to perform appendectomy.

Appendiceal perforation, necrotizing groin infection and spermatic cord necrosis in a case of Amyand's hernia

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Amyand’s hernias are an uncommon variant of inguinal hernia.

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Early recognition of this hernia type may improve patient care and outcome.

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Treatment for Amyand's hernias is dictated by additional factors, which has led to a classification scheme.

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There is no consensus on the approach to repair of these hernias but various described approaches have shown success.

Introduction

Inguinal hernias containing the appendix are described as Amyand’s hernias. The surgical approach to these types of hernias is dependent on the type present and associated intra-operative findings.

Presentation of case

We present a case of complicated type IV Amyand’s hernia, which was managed though combined abdominal and inguinal approach. Though the patient had a prolonged post-operative course due to pulmonary embolism, he progressed to full recovery.

Discussion

The different grades of Amyand’s hernia are repaired in varying ways, including laparoscopic and open approaches with or without mesh. The type of repair must be tailored to the patient and disease process.

Conclusion

Primary repair of a perforated Amyand’s hernia provides adequate strength with decreased risk of infection due to synthetic material.