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

Acute appendicitis within an incisional hernia: a type of Amyand's hernia

A man in his 60s presented to the emergency department with generalised abdominal pain and distention associated with the inability to pass stool or gas. The patient had undergone a laparoscopic partial right nephrectomy due to renal cell carcinoma a year ago. The workup diagnosis suggested an incarcerated incisional hernia. Surgical treatment was proposed. Intraoperatively, we found an ileocecal appendix with a macroscopically gangrenous appearance inside the hernia sac. An appendectomy was performed, and the hernia defect was closed using a tension repair. Amyand's hernia, a rare condition, is classically described as an inguinal hernia containing the appendix, but it can also refer to an incisional hernia containing the appendix. Amyand's hernia classification depends on the localisation of the hernia sac and its contents, including the presence or absence of appendix inflammation.This case report described a patient with Amyand's hernia, which was diagnosed intraoperatively. The treatment was also discussed including open appendectomy and primary repair of the defect using a tension repair approach.

Amyand's hernia a case report

INTRODUCTION AND IMPORTANCE

Amyand's hernia (AH) is a form of inguinal hernia which is consider as very rare and this type of hernia occurred up to 1% of all inguinal hernia cases. In this type of inguinal hernia, the content of hernia sac is appendix. Most patient with AH often remains asymptomatic and diagnosed intraoperatively. The diagnosis is challenging, since needs a high index of suspicion and imaging is key. Surgery is the mainstay management. We report a case of Amyand's hernia that was managed operatively in our medium complex public institution.

CASE PRESENTATION

A 28 year's old man with normal body mass index (BMI) who had a history of right-side reducible linguino-scrotal swelling for 8 years, was admitted for elective right inguinal hernia repair. Two weeks back before admission, he noticed that swelling was slightly painful. Ultrasound of the abdomen reported normal findings. There was no history of abdominal pain and vomiting. Laboratory parameters were within normal limit. So, with a diagnosis of right sided partially reducible, incomplete, and indirect inguinal hernia, patient was operated for open hernia repair surgery, intra operatively we found dense adhesions within the sac, adhesions were released which revealed herniation of appendix into the inguinal canal. Appendix was mildly congested without gross evidence of inflammation. Hence, in view of noninflamed appendix, preperitoneal mesh (polypropylene) hernioplasty from Lichtenstein tension-free mesh repair was performed with appendicectomy. Postoperative period was uneventful, patient discharged at second day.

CLINICAL DISCUSSION

Amyand's hernia is very uncommon and characterized by the presence of the appendix in the hernia sac and it is 0.4-1% of all inguinal hernia cases, literature review also showed that incidence of Amyand's hernia is very rare, whereas only 0.1% of cases complicate into acute appendicitis due to late presentation and missed diagnosis.

CONCLUSION

Amyand's hernia (AH) makes up only a small proportion of most inguinal hernia cases, and its diagnosis is usually based on incidental finding intra-operatively. This condition may remain asymptomatic and behave like a normal inguinal hernia. Management of this type of hernia should be individualized according to appendix's inflammation stage, presence of abdominal sepsis and co-morbidity. With this approach it enables surgeons to manage more variations of Amyand's hernia. Laparoscopy for dealing Amyand's hernia is frequently diagnostic as well as therapeutic.

Retrospective Evaluation of Ileocolic Artery and Vein Diameters according to Body Mass Index in the Diagnosis of Acute Appendicitis on Multislice Computerized Tomography

Objectives:

We aimed to investigate the diagnostic value of the increasement in the ileocolic artery and vein diameters considering the body mass index (BMIs) of the patients with acute appendicitis.

Methods:

Between January 2016 and April 2019, 76 patients who were diagnosed with acute appendicitis by contrast-enhanced abdominal multislice computerized tomography (MSCT) and had histopathologically confirmed appendicitis after an appendectomy were included in this study. To evaluate the value of MSCT, we created a control group, which consisted of 81 patients who had contrast-enhanced MSCT for other reasons and had no clinical and radiological findings suspicious for acute appendicitis and also had no other abdominal pathology that might interfere with ileocolic artery and vein diameter. In both groups, ileocolic artery and vein diameters were measured in axial MSCT scan. The body mass index was calculated for each patient (kg/m²). Both groups were divided into three subgroups according to the BMI of patients (20-24.9; 25-29.9 and more than 30). Both groups and subgroups were compared individually. Statistical significance level was accepted as p <0.05.

Results:

Ileocolic artery and vein diameters were higher in the patient group than control group, which was statistically significant (p<0.001), and a positive correlation was found between BMI and ileocolic artery and vein diameters (p < 0.001).

Conclusion:

Ileocolic artery and vein diameters with taking BMI into consideration can be used as alternative criteria in the suspicion of acute appendicitis in adults.

Incarcerated Amyand's hernia: A case report

INTRODUCTION

Inguinal hernia may contain vermiform appendix in very rare cases. This particular condition is known as Amyand's hernia and it has an incidence of 1%. Diagnosis is very difficult preoperatively, so it is usually an incidental finding.

PRESENTATION OF CASE

We report a case of a 80 year old man with an irreducible mass in right inguinal region. During surgical procedure an Amyand's hernia was identified and we performed hernioplasty sec Trabucco and appendectomy.

DISCUSSION

According to Losanoff and Basson classification, our case was type 1 and its management is very controversial.

CONCLUSION

Surgical treatment depends on surgeon's experience and on clinical evaluation because there are many factors that may increase morbidity and mortality.

Case report: Amyand's hernia, diagnosis to consider in a routine procedure

Amyand hernia is a rare entity that is generally an unexpected intraoperative finding. The decision to perform prophylactic appendectomy, must take into account individual factors that may increase morbidity in a short, medium or long term future.