Amyand's Hernia: Study of four cases and literature review

Amyand's hernia: a case report

An Amyand's hernia is a type of inguinal hernia where the appendix protrudes into the hernial sac. Pre-operative diagnosis is clinically challenging and ultimately the diagnosis is made intra-operatively. We report on a 75-year-old lady who presented with abdominal pain and a lump in her right groin region. She proceeded to theatre and had a diagnostic laparoscopy where she was diagnosed with an Amyand's hernia. The appendix was mildly inflamed and there was an ischemic appearance of the mesoappendix. According to the guidelines proposed by Losanoff and Basson she subsequently underwent a successful laparoscopic appendicectomy and primary repair of the hernia.

Left-Sided Acutely Irreducible Terminal Ileum Hernia With Cecum, Appendix, and Sliding Sigmoid: Case Report and Review of the Literature

Amyand's hernia is the presence of the vermiform appendix within the inguinal hernia sac, while a sliding hernia involves the herniation of a retroperitoneal organ outside the abdominal cavity. The hernia sac can contain various intraabdominal organs, including the small bowel, cecum, appendix, omentum, or ovary and fallopian tube. A hernial sac containing the appendix on the left side is rare, and the presence of other organs in combination is also uncommon. We are presenting a case of a 45-year-old male who presented with irreducible left inguinal swelling and obstructing symptoms. Interestingly, a large left indirect hernia sac was seen intraoperatively containing incarcerated cecum, terminal ileum, appendix, and sliding sigmoid colon. Left-sided incarcerated terminal ileum, cecum, appendix, and sliding hernia can be challenging because the symptoms are often nonspecific. However, surgery is often the only way to definitively diagnose these types of hernia.

Uncomplicated Amyand's hernia in a setting of abdominal wall insufficiency: a case report

INTRODUCTION

Amyand's hernia, an uncommon condition characterized by the presence of the appendix within an inguinal hernial sac (< 1% incidence), poses diagnostic and therapeutic challenges. Often it is an intraoperative finding, with almost no clinical symptoms.

CASE PRESENTATION

This is a case of an Indian male in his early 80 years, diagnosed with bilateral direct inguinal hernias, one of which contained a noninflamed appendix. Given the thinned out abdominal wall, dense adhesions, and no demarcation between layers, the decision to proceed with a modified Bassini's with Lichtenstein mesh repair without appendectomy, guided by intraoperative findings and the Losanoff-Basson Classification, reflecting the complex interplay between individual patient factors and intraoperative considerations. The patient did well during his postoperative stay and was in good health on a 45 day follow-up, with no complaints suggestive of recurrence or obstruction.

CONCLUSION

This case underscores the importance of tailored management strategies and highlights, especially in cases where recurrence and postoperative wall integrity are in question, the ongoing need for research to refine treatment guidelines for Amyand's hernia, especially in cases of appendicitis not diagnosed preoperatively.

Amyand's hernia and associated acute appendicitis: A case report

INTRODUCTION

Amyand's hernia is incarceration of vermiform appendix within inguinal hernia. Amyand's hernia associated with acute appendicitis is rare.

CASE PRESENTATION

A male in his 5th decade of life presented with enlarged right reducible inguinal scrotal swelling and each episode of incarceration relieved manually. Background history of a movement disorder. Ultrasound reported right inguinoscrotal hernia with bowel content but no obstruction seen with plain abdominal x-ray. Elective right open inguinoscrotal repair was done. Intraoperative findings included enlarged superficial ring, enlarged hyperemic appendix in indirect hernia sac adhering to caecum. After appendectomy, the sac was transfixed above caecum. Hernioplasty was done with a polypropylene, poliglecaprone 25, macroporous and partially absorbable mesh. Immediate post-operative period was uneventful. Last review at 7 months showed no complication.

CLINICAL DISCUSSION

About 1 % of inguinal hernias retain part or whole appendix. In Amyand's hernia, 0.07-0.13 % of appendix is more prone to trauma, impaired vascular supply, inflammation, and microbial multiplication. Index patient's appendix was inflamed and histology confirmed focal acute transmural inflammation and denudation of appendiceal epithelial walls. Mesh repair is generally contraindicated in appendicitis or ruptured appendix but no post-operative complication occurred in index patient up to 7 months after appendectomy via the hernia with mesh repair.

CONCLUSION

Amyand's hernia with acute appendicitis is rare. Though use of mesh during surgery is controversial, hernioplasty was done in index patient because of the predisposing history of a movement disorder and recurrence rate of herniorrhaphy.

Management of a Patient With an Obstructed Inguinal Hernia With Amyand's Variety: A Report of a Rare Case With a Review of the Literature

Amyand's hernia is a rare form of inguinal hernia, where the appendix is located within the inguinal sac. A 66-year-old male presented with an obstructed, incarcerated right inguinal hernia. He underwent an emergency herniotomy under spinal anesthesia. Intraoperatively, the hernia sac contained a viable small bowel and part of the appendix. As the appendix appeared mildly inflamed, an appendicectomy was performed, and a synthetic mesh repair was done. He received a postoperative course of antibiotics and was discharged home on day 3 after an uneventful recovery. Histology of the appendix revealed a fecolith in the absence of acute inflammation. He did not have any procedure-related complications on follow-up. Preoperative diagnosis of Amyand's hernia is a challenge due to nonspecific symptoms and rarity. Lasanoff and Basson classify Amyand's hernia and provide surgical guidance for its management. Our case belonged to the type 2 category. Management of Amyand's hernia needs an individually tailored approach rather than strict adherence to conventional guidelines. The presence of an appendicular fecolith in the absence of inflammation provides an interesting area to explore in an Amyand's hernia.

Amyand's hernia: a case of right inguinoscrotal hernia with appendiceal content

Introduction

Amyand's hernia, a rare condition where the appendix becomes lodged in the inguinal canal, poses diagnostic challenges due to its varied clinical presentations and lack of distinctive radiological features. This case underscores the importance of early detection and comprehensive diagnostic evaluation.

Case Presentation

A 30-year-old male presented with a 2-year history of right inguinoscrotal swelling, culminating in agonizing symptoms and irreducible masses over the inguinoscrotal area. Despite the absence of significant medical history, diagnostic imaging confirmed a complete right inguinoscrotal hernia and bilateral hydrocele with internal echoes.

Clinical Discussion

The case illustrates the difficulties in preoperative diagnosis of Amyand's hernia, emphasizing the reliance on imaging modalities and clinical assessment. Successful surgical intervention involving appendectomy and hernioplasty highlights the necessity for prompt diagnosis and management.

Conclusion

This case exemplifies the challenges and complexities associated with Amyand's hernia, emphasizing the importance of early recognition and comprehensive surgical planning. Moving forward, increased clinical vigilance and awareness are essential to ensure optimal patient outcomes in cases of inguinoscrotal pathology.

Amyand's Hernia With Sliding Component: A Case Report

Amyand's hernia (AH) occurs when the appendix becomes part of an inguinal hernia. Amyand's hernias are typically discovered incidentally during surgery due to their variable clinical manifestations and features, such as caecum and appendix forming the sliding component in the present case. Claudius Amyand operated it for the first time in 1735. Due to the simple presentations that these patients typically exhibit, the diagnosis is extremely challenging. The choice between surgical modalities is influenced by the numerous, logically accepted advantages and disadvantages of management modalities, which are subject to debate. That being said, we believe that, in the absence of sepsis or inflammation, open repair using mesh - as long as a clean operating room and competent surgical skill are available - should be the gold standard approach.

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 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.

Fishbone-Induced Appendicular Perforation: A Rare Case Report of Amyand's Hernia

Amyand's hernia is a rare type of hernia where the appendix is found to be the content of the inguinal hernial sac. It is most often diagnosed intraoperatively wherein the appendix may be found healthy, incarcerated, inflamed, or perforated. Claudius Amyand performed a successful appendectomy on a patient with an appendix noted in the inguinal canal and this condition was hence named after him. The incidence of Amyand's hernia is rare in inguinal hernia patients. There are no defined guidelines for the management of Amyand's hernia but adequate resuscitation followed by immediate appendectomy is widely followed. Here is a case report of a 60-year-old male presenting to the Emergency Department with an irreducible right-side inguinal hernia with features of small bowel obstruction. On exploration, Amyand's hernia was identified with appendicular tip perforation due to an impacted fishbone with pyoperitoneum. Appendectomy was done through midline laparotomy with impacted fishbone removal from the hernial sac with tissue repair of the hernia. There are as such no reported cases of fishbone-induced appendicular perforation in an Amyand's hernia in the available literature. After the exploration, we found the management of the case challenging regarding the closure of the hernia.

Amyand's hernia combined with contralateral recurrent inguinal hernia: A case report

INTRODUCTION

Amyand's hernia (AH)-where the appendix becomes incarcerated within the inguinal hernia (IH) sac-is rare, particularly if detected and operated concurrent with a contralateral recurrent IH.

PRESENTATION OF CASE

A 65-year-old man presented with symptomatic bilateral IH; the left IH was recurrent. Abdominopelvic computed tomography (CT) revealed a right IH with appendiceal herniation and left recurrent IH with omental fat. Using the prolene hernia system (PHS) mesh, the left recurrent IH underwent operation, followed by the right AH. The patient was in a good state with no recurrence 16 months postsurgery.

DISCUSSION

If AH is accidentally encountered during surgery, the procedure should differ depending on the inflammatory state of the appendix. Simultaneously operating AH and contralateral recurrent IH is complicated; it is necessary to preoperatively decide which side to operate on first and whether to use an anterior or laparoscopic posterior surgical approach. If the planned operation is unattainable, alternative surgery should be considered. Fortunately, herein CT was performed prior to surgery, and the surgical plan was properly established.

CONCLUSION

Prior to simultaneous AH and contralateral recurrent IH surgery, the surgical plan should be established. If the planned surgical technique for recurrent hernia repair is not feasible, an alternative should be performed. In AH repair, different surgical methods are required depending on the presence and severity of inflammation of the appendix.

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.

Inguinal Hernia Containing an Inflamed Appendix: A Case of Amyand Hernia

Inguinal hernia is a prevalent surgical condition worldwide. The hernia sac typically contains the omentum and small intestine. However, it has been reported that some other organs might be seen, including the ovary, fallopian tube, bladder, and colon. We report the case of a 23-year-old man who presented to our emergency department with the complaint of scrotal pain for the last six days. The pain was mainly in the right side. There was no history of preceding trauma, and the pain developed gradually. He described the pain as having a sharp nature and was constant. He reported having a low-grade fever that resolved with the use of over-the-counter analgesics. There was no change in the urine or bowel habits. No penile discharge was reported. On examination, the patient had a low-grade fever and tachycardia. The patient appeared in pain and was not cooperative to have a complete genitalia examination. However, there was a positive cough impulse in the right inguinal region. The laboratory findings suggested the presence of inflammatory or infectious processes with elevated leukocytes, C-reactive protein, and erythrocyte sedimentation rate. The patient was prepared for emergency laparotomy for reduction of the hernia and resection of the appendix. During exploration, the appendix was reduced from the hernia sac. The appendix appeared edematous, with marked erythema representing acute appendicitis. The appendix was resected and the hernia sac was closed. The presence of an appendix in the inguinal hernia sac is very rare. The preoperative diagnosis of Amyand hernia, the inguinal hernia containing the appendix, can be difficult based on the clinical presentation. Early diagnosis is crucial to avoid the potential complications of Amyand hernia, including perforation and abscess formation. Imaging studies can establish the diagnosis of Amyand hernia with high accuracy and confidence.

Left-Sided Amyand Hernia: Case Report and Review of the Literature

Left-sided Amyand hernia is a rare condition that requires a high degree of clinical suspicion to correctly diagnose.

Amyand's hernia- outcome of nylon darn repairs after complicated appendix surgeries in a district hospital: case series

INTRODUCTION

Complicated appendix is a least expected sac content of inguinal hernias that always require appendix surgery and hernia repair. The current recommendations for posterior wall repairs however, continue to attract conflicting views as to which modality gives the best outcome in infected surgical wounds. New posterior wall repair methods with properties to withstand surgical site infections, minimise hernia recurrence, affordable and easy skill to acquire with a potential to be widely adopted are continuosly sort.

AIM

To determine the surgical outcomes of complicated Amyand Hernias repaired using the open tissue base Nylon Darn posterior wall re-enforcement method.

METHOD

A retrospective review of medical records of patients who had surgery for emergency inguinal hernia with intra-operative confirmation of complicated appendix in the hernia sac from January 2015 to December 2020 at the Margaret Marquart Catholic Hospital, Kpando were included. Data on age, sex, clinical presentation, surgical procedure, intra-operative findings, post operative complications were captured and presented as descriptive statistics.

RESULTS

Twelve out of 286(4.6%) repairs were complicated Amyand Hernias in patients aged 6weeks to 76-years{median age 54.5-years}. Most of them were adults, long-standing hernias. All diagnosis were made on-table. Surgical site infections was the most frequent complication in types III and IV AHs which resolved with antibiotic treatment.

CONCLUSION

The incidence of complicated AHs is higher and should be anticipated in surgeries for long-standing complicated inguinal hernias. Even though complications were significantly associated with longer hospital stay, no second procedure or mortality was recorded.

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.

Sliding Amyand's hernia: a case report and review of literature

First operated by Claudius Amyand in 1735. Amyand's hernia is a rare presentation and accounts for only 1% of all inguinal hernias. Amyand's hernia is described when the appendix is trapped within an inguinal hernia. In most cases, Amyand's hernia is an incidental finding intra-operatively due to variable clinical manifestations, and features. Amyand's hernia has variable theories explaining its pathophysiology besides having multiple proposed surgical approaches either via laparoscopic or open repair and with the latter being in a debate of pro and against mesh repair. We present a case of a sliding Amyand's hernia in which the vermiform appendix and part of the cecum were adherents to the wall of a right inguinal hernial sac. Amyand's hernia is a rare form of inguinal hernias and its presentation is widely variable. However, in most cases, it is non-complicated and is found as an incidental intraoperative finding. Many studies debate among different diagnostic and management approaches to serve a better outcome with fewer operative complications.

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

PURPOSE

To identify and sum all available evidence pertaining to the management of Amyand's hernia (AH).

METHODS

A systematic search of the MedLine, Scopus, and Google Scholar databases was performed for studies published until January 2020.

RESULTS

In total, 111 studies incorporating 161 patients were identified, 96 (86.4%) being case reports, 11 (9.9%) case series, and 4 (3.7%) retrospective patient cohorts. Mean patient age was 58.5 ± 19.6 years with 136 (83.9%) being males and 25 (16.1%) females. Furthermore, 149 (92.5%) cases were right-sided hernias while 12 (7.5%) cases were left-sided. Overall, 62.3% of patients presented emergently and 77.3% of patients' cohort were eventually diagnosed with incarcerated AH. Preoperative diagnosis of AH was established in 23.1% of patients and was achieved either by ultrasound (25%) or CT scan (75%). Operative findings consisted of normal appendix in 73 (45.4%) cases, uncomplicated appendicitis in 62 (38.5%) patients, and perforated appendix in 26 (16.1%). Regarding patients with appendicitis, mesh placement was reported for 17 (21.2%), herniorrhaphy was performed for 51 (63.7%) while 12 (15.1%) patients did not undergo hernia repair during the initial operation. Mesh utilization rates were significantly higher in patients with a normal appendix. Seven cases involved AH containing appendiceal neoplasms. Thirteen cases (8.6%) of postoperative complications were documented and a single case of postoperative death.

CONCLUSION

AH is a rare type of inguinal hernia usually complicated by appendicitis. Hernia reconstruction should be tailored to each patient individually according to the extent of inguinal canal inflammation.

First sliding Amyand hernia harbouring appendicular schistosomiasis: Case report

INTRODUCTION

Amyand's hernia (AH) is rare, schistosomiasis of the appendix is very uncommon, and both conditions coexisting together is an extremely rare event. Pre-operative diagnosis of each of the two conditions is usually difficult. To the best of our knowledge, the current paper is first to report both these two conditions in coexistence.

PRESENTATION OF CASE

A 31-year old man who had no comorbidities was admitted electively as a day case of non-complicated right indirect inguinal hernia. Further history and physical examination were unremarkable. Intraoperatively the patient was found to have right sliding AH with appendicular schistosomiasis (AS). The patient underwent Lichtenstein repair of the hernia with appendectomy. On follow up he was referred to infectious disease clinic, and the post-operative course was uneventful.

CONCLUSIONS

Intraoperative identification of non-typical hernia sac before its opening should alert the surgeon to the possibility of sliding hernia and the presence of an organ as a part of the sac. Rare causes of appendicular masses like schistosomiasis granuloma should be considered in endemic areas or immigrants from these areas, despite the difficulty of preoperative diagnosis. Management should follow general guidelines of appendectomy, hernia repair and dealing with the associated pathology if present.

Amyand's Hernia: A Rare Surgical Pathology of the Appendix

Amyand’s hernia is characterized by the presence of an inflamed, non-inflamed or perforated appendix within the sac of an inguinal hernia. This is an exceedingly rare presentation and most of the cases are diagnosed incidentally during surgery. Here we describe a case of an Amyand’s hernia in a patient who presented in our outpatient clinic with an irreducible right-sided inguinal hernia. There were no signs of ischemic complications. During the surgery, an appendix was found within the hernial sac. An uneventful appendectomy along with a tension-free darn repair was performed. The current case report emphasizes that this pathology must be kept in mind while treating a patient with a right-sided inguinal hernia.

Amyand's hernia: A case report and review of the literature

INTRODUCTION

An Amyand hernia is a rare disease where the appendix is found within an inguinal hernia sac. This rare entity is named after the French born English surgeon, Dr. Claudius Amyand. Inguinal hernias are one of the most common surgeries that a general surgeon performs with more than 20 million inguinal hernia repairs performed yearly worldwide. The incidence of finding an appendix within the hernia sac is rare, occurring in less than 1% of inguinal hernia patients and when complications arise such as inflammation, perforation, or abscess formation it becomes exceptionally rare with an incidence of about 0.1%.

PRESENTATION OF CASE

A 59-year-old male with a history of a previously reducible right inguinal hernia presented to the Emergency Department with acute abdominal pain, right groin mass. Computed tomography (CT) confirmed a right incarcerated inguinal hernia with herniated loops of bowel within the right inguinal region. Patient was subsequently treated with an appendectomy and tension free hernia repair with mesh with a successful outcome.

DISCUSSION

The current generally accepted treatment algorithm for Amyand's hernia is essentially contingent on the appendix's condition within the hernia sac. Controversy exists regarding the application of mesh in type 2 Amyand's hernia. More research is needed to provide surgeons with evidence-based standardized approaches for dealing with this unique situation.

CONCLUSION

This case report reviews a rare entity known as an Amyand's hernia that presented as an incarcerated hernia that was diagnosed intraoperatively with an inflamed appendix, recognized as a type 2 Amyand's hernia.

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.

Unusual Entities of Appendix Mimicking Appendicitis Clinically - Emphasis on Diagnosis and Treatment

BACKGROUND

Abdomen is considered a magic box or a Pandora box where you will get different, unexpected pathologies along with rare entities. Appendicitis is the commonest emergency in surgery which presents challenges to surgeons because of a myriad list of differential diagnosis including both medical and gynaecological pathologies. Preoperative imaging plays an important role in diagnosis and management.

AIMS AND OBJECTIVES

To study the rare atypical anatomical and surgical presentations of appendix in patients with clinical features of appendicitis. We focus on the clinical features and the role of investigations for the radiological part and management.

MATERIAL AND METHODS

This study was done in M.M. Institute of Medical Sciences and Research, Mullana, Ambala, from November 2014 to July 2016. This was a retrospective study. We found 168 cases with the diagnosis of appendicitis, out of which 19 were with rare entities.

RESULTS

Subjects of both genders were aged between 20 and 60 years. Out of 19, 15 were males and 4 females. Four patients were operated for inguinal hernia but incidentally we found appendix in the hernial sac termed as Amyand's hernia. Another patient presented with obstruction and appendix was forming a band diagnosed as torsion of appendix. Two most interesting cases were diagnosed as appendicular neuralgia and relieved by appendectomy. Out of 19 cases, 7 cases were operated for appendicitis diagnosed as appendicolith. In all the cases appendectomy was done without encountering any complications. Symptom free patients were operated for appendicular neuralgia. No malignancy was found in mucocele appendix at follow up. There were no complications by the 6-month follow-up.

CONCLUSION

As we came across with different entities of appendix presented with appendicitis, patients should be investigated before proceeding for surgery. In our study, there were incidental findings for which surgeons were not aware of the diagnosis and even for the patient. In inguinal hernia, ultrasonography was not done, diagnosis being made on clinical basis. Clinical and radiological investigations play an important part in early diagnosis and management.

A complicated case of amyand's hernia involving a perforated appendix and its management using minimally invasive laparoscopic surgery: A case report

INTRODUCTION

Amyand's hernia is a rare condition of inguinal hernia in which the appendix is incarcerated within the hernia sac through the internal ring. Complications include acute appendicitis and perforated appendicitis, which are rare in incidence, accounting for about 0.1% of cases.¹ These complications prove a diagnostic challenge due to their vague clinical presentation and atypical laboratory and radiological findings. Until recently, open appendectomy was the mainstay of treatment. Laparoscopic surgery offers a less invasive approach to confirming a diagnosis and serving as a therapeutic tool in equivocal cases.

CASE PRESENTATION

We report a case of a previously healthy 20-year-old male presenting with atypical signs and symptoms, as well as blood investigation results, and radiological findings of a perforated appendix within an Amyand's hernia. The patient was successfully managed using a minimally invasive laparoscopic appendectomy approach.

DISCUSSION

Until recently, open appendectomy was considered the mainstay in the management of complicated Amyand's hernia. Laparoscopic surgery provides a new avenue for dealing with diagnostic uncertainty with advantages including faster recovery time, reduced hospital stay, and better quality of life.

CONCLUSION

This case report highlights the concealing effects of an Amyand's hernia on a perforated appendix, the considerations required when an equivocal diagnosis present and the safe use of the minimally invasive laparoscopic surgery in the treatment of this rare condition.

Amyand's Hernia: Rare Presentation of a Common Ailment

Inguinal hernia with vermiform appendix as content is known as Amyand's hernia. It is a rare entity but we encountered four cases within six months. A 52-year-old female had high grade fever and evidence of inflammatory pathology involving the ileocaecal region. She was initially managed conservatively and subsequently underwent exploratory laparatomy. The appendix was perforated and herniating in the inguinal canal. Appendectomy was done with herniorrhaphy without mesh placement. A 74-year-old male with bilateral inguinal hernia, of which, the right side was more symptomatic, underwent open exploration. Operative findings revealed a lipoma of the sac and a normal appearing appendix as content. Contents were reduced without appendectomy and mesh hernioplasty was performed. A 63-year-old male with an obstructed right sided hernia underwent emergency inguinal exploration which revealed edematous caecum and appendix as content without any inflammation. Contents were reduced without any resection. Herniorrhaphy was performed without mesh placement. A 66-year-old male with an uncomplicated right inguinal hernia underwent elective surgery. The sac revealed an appendix with adhesions at the neck. Contents were reduced after adhesiolysis and hernioplasty was performed with mesh placement. Emphasis is made to the rarity of disease, variation in presentation, and difference in treatment modalities depending upon the state of appendix.

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.