Implications of the presence of the vermiform appendix inside an inguinal hernia (Amyand's hernia): a systematic review of the literature

Management of Perforated Appendicitis in Amyand's Hernia: A Multidisciplinary Approach to Complex Postoperative Complications

Amyand's hernia is an exceptionally rare condition in which the appendix is located within an inguinal hernia sac. While it is typically asymptomatic, the occurrence of appendicitis or perforation within these hernias presents significant diagnostic and therapeutic challenges. We report a unique case involving a 31-year-old male patient who developed perforated appendicitis within an Amyand's hernia, resulting in severe intra-abdominal infection and complex postoperative complications, including the formation of multiple abscesses at three different sites. A multidisciplinary approach, involving general surgery, infectious disease, interventional radiology (IR), and urology, was crucial for effective source control and infection management. This case underscores the importance of individualized surgical decision-making in cases of Amyand's hernia with significant inflammatory involvement, emphasizing the necessity for timely recognition and intervention to minimize complications and improve patient outcomes.

Amyand's Hernia diagnosed preoperatively via a CT scan: A case report

Amyand's hernia is a rare type of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. It was named after Claudius Amyand who performed the world's first successful appendectomy on an 11-year-old boy with a right inguinal hernia in 1735 and discovered a herniated appendix during surgery. This condition warrants urgent surgical treatment, with the type of surgical intervention depending on the appendix's condition. However, the nonspecific clinical presentation often complicates the preoperative diagnosis, emphasizing the critical role of imaging in surgical planning. Herein, we present the case of a 74-year-old male who presented with fever, inguinal swelling, and discomfort. Clinical suspicion of inguinal and scrotal inflammation prompted us to perform a prompt CT scan. This radiological evaluation led to a preoperative diagnosis of a Type 3 Amyand's hernia. This case highlights the significance of CT scans in the accurate and timely diagnosis of Amyand's hernia. Distinguishing between various types of Amyand's hernia is pivotal as it profoundly influences surgical decision-making and postoperative outcomes. By sharing this case, we contribute to current knowledge about Amyand's hernia, increase clinical awareness of the condition, and emphasize the crucial role of imaging in its management.

Complicated Appendicitis Associated With Appendiceal Mucinous Neoplasm Within Amyand's Hernia in a Patient With Previous Hernia Repair: A Case Report and Literature Review

Amyand's hernia is defined as the presence of the appendix within an inguinal hernia sac, which is often associated with appendicitis. The association of an Amyand's hernia with an appendicular tumor has been reported in very few cases. This case report presents a 67-year-old female patient who came to the emergency department with symptoms indicative of a complicated inguinal hernia. Following surgical treatment, the diagnosis of Amyand's hernia with cecal perforation associated with an appendicular tumor was established in the context of a previous laparoscopic femoral hernia repair. The combination of these conditions has not been previously reported. The presentation of this case provides data on the clinical presentation, diagnosis, and treatment of this rare pathology that requires a high clinical suspicion to achieve a preoperative diagnosis.

Laparoscopic surgery for De Garengeot's hernia in a man after inguinal hernia surgery with a mesh plug: a case report and review of literature

BACKGROUND

De Garengeot's hernia is a rare case of a femoral hernia that contains the appendix. Here we report a case of De Garengeot's hernia that occurred in a male patient who had a history of inguinal hernia surgery using a mesh plug. There were no reports of De Garengeot's hernia with a history of surgery for inguinal hernia, and the surgical question was whether we could successfully treat a patient with minimally invasive laparoscopic surgery using a mesh.

CASE PRESENTATION

This case involved 75-year-old man with a history of right indirect inguinal hernia surgery using a mesh plug without on-lay mesh, who presented with a 5-day history of a right groin lump. Abdominal CT revealed an incarcerated appendix within the right femoral hernia and fluid collection around the appendix. Laparoscopic surgery was initiated and the incarcerated appendix was released with traction. There was no contamination around the appendix or the femoral ring, the appendix was removed, and the femoral hernia was repaired using mesh. Laparoscopic surgery was useful in first evaluating the inflammatory status of the appendix. As it was determined that there was little inflammation around the appendix and femoral ring, it was possible to repair the hernia using mesh.

CONCLUSIONS

De Garengeot's hernias are rare and there is currently no standardized approach. Even if it is a recurrent hernia in the groin, laparoscopic surgery can be useful for diagnosis and treatment, but the use of mesh requires further careful consideration.

Amyand's hernia with concurrent appendicitis: A case of interval laparoscopic herniorrhaphy and literature review

INTRODUCTION AND IMPORTANCE

Amyand's hernia with concurrent appendicitis is rare, with a reported incidence of 0.13 % of all inguinal hernias. This condition is challenging to diagnose and manage and no optimal treatment has been established.

CASE PRESENTATION

A 71-year-old man presented with an acutely painful, tender, and irreducible right inguinal hernia. He had a history of a right inguinal hernia for several months and had undergone open left inguinal hernia repair. The patient had no other medical comorbidities. Blood test results were nonspecific, with a C-reactive protein of 90 mg/L. Ultrasound scan suggested a strangulated right inguinal hernia. Laparoscopy revealed an Amyand's hernia with concurrent appendicitis and a pus-filled right inguinal hernia sac. The patient underwent laparoscopic appendicectomy, followed by staged laparoscopic transabdominal preperitoneal right inguinal hernia repair with mesh after eight weeks to reduce mesh infection. Histopathological examination confirmed acute uncomplicated appendicitis without perforation or malignancy. The patient had an unremarkable post-operative recovery.

DISCUSSION

This case highlights the diagnostic challenges associated with Amyand's hernia and concurrent appendicitis. Laparoscopy provides both diagnostic and therapeutic opportunities. In this case, laparoscopic mesh herniorrhaphy was delayed and staged until local hernia sac inflammation resolved following appendicectomy.

CONCLUSION

Surgeons should have an index of suspicion for Amyand's hernia given the heterogeneity of presentations. A case-by-case approach is required to prevent post-operative complications and determine the safe timing of definitive hernia repair when the inguinal hernial sac is inflamed. Further research is required to provide surgeons with evidence-based approaches for this unique condition.

Amyand's hernia repair in an asymptomatic patient-a case report and a review of the literature

Amyand's hernia is a rare condition, in which the appendix is found in the inguinal hernia sac. Many patients remain asymptomatic and this pathological condition is most commonly diagnosed intraoperatively. We report a case of a 66-year-old male who was admitted to the hospital for an inguinal hernia repair and the presence of the appendix in the inguinal hernia sac was discovered intraoperatively. We performed a reduction of the appendix in the abdominal cavity and a hernia repair with a mesh and a plug. There are few studies in literature about the appropriate method of treatment and, because of that, the therapeutic approach remains controversial. Therefore, we also conducted a review of the literature in order to obtain some conclusions regarding the management of Amyand's hernia.

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.

Amyand's hernia with a perforated appendix and an enterocutaneous fistula: A case report

INTRODUCTION

Amyand's hernia is a rare finding accounting for less than 1 % of inguinal hernias. The appendix with its pathology within the hernia sac may become isolated from the gastrointestinal tract, which can cause further confusion in clinical diagnosis. Awareness of the possibility of such appendiceal isolation could aid in clinical diagnosis. We report a rare case of Amyand's hernia complicated with a perforated appendix and an enterocutaneous fistula.

PRESENTATION OF CASE

A 64-year-old gentleman with diabetes mellitus type II and hypertension presented with a right inguinal swelling associated with a malodorous discharge without features of intestinal obstruction. Ultrasonography revealed a right inguinal hernia with features of partial strangulation. He underwent a right inguinal exploration with subsequent debridement, appendicectomy and a herniorraphy. The patient had complete recovery and histopathology revealed acute appendicitis.

DISCUSSION

Amyand's hernia is rare and difficult to diagnose pre-operatively. Appendicitis in Amyand's hernia is rarer still and may be caused by intraluminal or extraluminal obstruction. Clinical presentation is variable and ultrasonography and computed tomography (CT) scan aid in diagnosis. Appendicectomy is regarded as unnecessary when the appendix is normal. Synthetic mesh should be avoided when the appendix is inflamed or perforated.

CONCLUSION

Amyand's hernia is rare and difficult to diagnose. Ultrasonography and CT scan are valuable tools for pre-operative diagnosis. Isolation of the appendix with its pathology within the hernia sac can add to the confusion in clinical diagnosis. Management of Amyand's hernia should be tailored according to the pathology encountered and treatment should not be delayed.

Amyand hernia as a rare cause of abdominal pain: A case report and literature review

Key Clinical Message

Amyand's hernia is an uncommon kind of inguinal hernia in which the appendix becomes entrapped within the hernia sac. In patients with an inflamed or perforated appendix, mesh repair is not recommended for hernia repair.

Abstract

Amyand's hernia is an uncommon kind of inguinal hernia in which the appendix becomes entrapped within the hernia sac. We report a 48-year-old man with a right groin protrusion and abdominal pain. In the abdominopelvic ultrasound, an appendix with a diameter of 9 mm was reported in the right inguinal canal. The patient was diagnosed with Amyand hernia.

Left sided Amyand hernia - A case report

INTRODUCTION

Amyand hernia is a clinical condition wherein content of the inguinal hernial sac is formed by the vermiform appendix.

CASE PRESENTATION

1 year 3-month-old male child presented to our OPD with an irreducible left inguinal hernia for which he was taken up for an emergency herniotomy. The terminal ileum, caecum and appendix were found to be the contents of the hernial sac.

DISCUSSION

As the appendix is anatomically located on the right, Amyand hernia more commonly occurs on the right, however its occurrence on the left, is a rare event and is usually associated with congenital anomalies like Intestinal malrotation, Situs inversus and mobile caecum.

CONCLUSION

Amyand hernia presenting on the left is extremely rare and high index of clinical suspicion is required to manage such patients. We report one such rare case of a Left sided Amyand hernia in a young child.

Amyand's hernia: a 10-year experience with 6 cases

PURPOSE

Amyand's hernia is a rare hernia defined as an inguinal hernia that contains the appendix within the hernia sac. Current treatment of Amyand's hernia remains controversial. Our study retrospectively reviewed 6 cases of Amyand's hernia, aiming to provide a reference for the surgical treatment of Amyand's hernia.

METHODS

Six patients diagnosed with Amyand's hernia from September 2010 to May 2020 were retrospectively enrolled in our study. We summarized clinical data of six patients including the chief complaint, physical examinations, laboratory examinations, imaging examinations, surgical methods, and postoperative treatments and outcomes.

RESULTS

The diagnosis of six cases with Amyand's hernia was made during surgery. Two patients had normal appendixes whereas the remaining four patients had appendicitis. Two patients with normal appendix received tension-free mesh repair through the inguinal incision. Among those with inflamed or perforated appendixes, two received mesh repair and the other two did not. The discharge time after surgery of six patients was 9.8 ± 6.1 days. One patient suffered from a wound infection. No additional postoperative complications were detected.

CONCLUSIONS

Computed tomography and ultrasonography are helpful but limited in the definite diagnosis of Amyand's hernia. The presence of a normal appendix does not require to be resected, but appendicectomy is necessary if the appendix is inflamed. The treatment of Amyand's hernia should be tailored based on the patient's condition and the type of Amyand's hernia.

Strangulated Amyand's hernia: management during the COVID-19 pandemic

Amyand’s hernia, presence of the appendix within an inguinal hernial sac, is a rare condition. We report a case of a 68-year-old woman who presented during the COVID-19 pandemic with an acute right groin pain due to a tender incarcerated inguinal hernia. Cross-sectional imaging confirmed an Amyand’s hernia. She proceeded to open appendectomy via the inguinal canal and primary suture repair of her inguinal hernia. Patient was discharged the following day. Surgical management of Amyand’s hernia varies depending on the resources, clinical findings and personal experience. In our opinion and experience, open hernia reduction, appendectomy and primary tissue repair repairs the most effective and appropriate approach especially during the COVID-19 pandemic.

Acute appendicitis located within Amyand's hernia-a complex case with concurrent acute cholecystitis

Amyand’s hernia is the presence of the vermiform appendix within an inguinal hernia sac. It is rare, and even rarer is the presence of acute appendicitis within the sac. It presents in a variety of different ways and often is only diagnosed intra-operatively. We present the case of a 90 year old male with extensive co-morbidities presenting with right upper quadrant pain, who on computed tomography scan of the abdomen, had acute cholecystitis alongside acute appendicitis within Amyand’s hernia. Ultimately given his co-morbidities, a conservative approach with prolonged antibiotic therapy was adopted, with a successful outcome. This case highlights that although classifications for treatment of Amyand’s hernia exist, careful clinical assessment is warranted in each case to ensure optimal outcome based upon individual circumstances.

Appendectomy or not in middle-aged male with non-inflamed appendix in Amyand's hernia? Case report and literature review

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Amyand’s hernia management remains controversial.

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Use of mesh or not in Amyand’s hernia.

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Role of CT scan in diagnosis of Amyand’s hernia.

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Literature review of Amyand’s hernia and classification systems.

Introduction

An Amyand’s hernia is a rare disease where a vermiform appendix is found within an inguinal hernia sac. It is reported in the literature as having an incidence between 0.4%–1.0% of reported hernia cases. Typically, an incidental finding, Amyand’s hernia is consequently found more frequently intra-operatively rather than preoperatively.

Presentation of case

This case is a recount of a 56-year-old male, who presented in an outpatient setting for the evaluation of right inguinal pain and bulge. The patient was diagnosed with a vermiform appendix within the indirect hernia. The patient underwent elective repair of his inguinal hernia via Transabdominal Preperitoneal (TAPP) approach of the hernia with avoidance of appendectomy.

Discussion

An Amyand’s hernia presents a challenging diagnosis and the treatment algorithm is contingent on the condition of the appendix in individual cases. This case presents a Type 1 Amyand’s hernia that was repaired through laparoscopic approach using prosthetic mesh. The aim of this case study highlights the approach to surgical decision making in the diagnosis and treatment of Amyand’s hernia proposed in the current literature.

Conclusion

This case presents a rare condition known as Amyand’s hernia followed by a discussion on the epidemiology, diagnostic workup, and treatment options. Treatment is dependent on the state of the appendix found in the hernia sac and the clinical scenario. Comprehensive literature review shows that the true prevalence of this disease is lower than classically described and still has no clear standardized approaches.