Amyand hernia: Case report and review of the literature

Abstract

IntroductionAmyand Hernia is a rare disease seen in approximately 1% of all hernias, complications of it, like acute appendicitis, or perforated appendicitis are even more rare, about 0.1%. Its diagnosis is very difficult in the pre-operative period; it is usually an incidental finding.Presentation of caseThis paper describes the case of a forty-year-old male patient, which was presented to the outpatient clinic of surgery with an incarcerated right side inguinal hernia without any signs of ischemic complications. He was admitted, and an hernioplasty was performed, as an incidental finding we encountered an Amyand hernia treated without appendectomy and placement of a prosthetic mesh without any complications.DiscussionThis disease represents a very challenging diagnosis, seven years ago the standardization of management had already been established; in this case we encountered a type 1 Amyand's Hernia so we performed a standard tension free hernioplasty without complications.ConclusionAmyand hernia is a rare condition, which represents two of the most common diseases a general surgeon has to face. Standardization of treatment is still ongoing and more prospective studies need to be done. This case demonstrates that this pathology must remain in the mind of the surgeons especially in the event of a strangulated hernia and offer a comprehensive review.

Amyand Hernia: A Literature Review of the Diagnosis and Management of the Rare Presentation of the Wandering Appendix

“…Although common in the inguinal hernia, the appendix has been reported to be found in incisional, obturator and umbilical hernias [2]. The presence of appendicitis within the sac is attributed to compression at the neck of the sac with resulting ischaemia and infection [3,4] which is an even rarer presentation accounting for 0.1% of all inguinal hernias [2,3,5]. Preoperative diagnosis is often a rare occurrence due to the fact that investigations are not usually ordered for a clinically diagnosed hernia and as such the diagnosis is made intra operatively in vast majority of times, however more recently, ultrasound and CT scanning has shown most promise in picking up these kind of hernias in the preoperative period where they are ordered to diagnose or rule out abdominal pathology [1,2,5].…”

“…Appendectomy through herniotomy with primary hernia repair will be the ideal treatment for such hernias in contrast to lower midline laparotomy which should be reserved for cases where complications are suspected [1]. Primary repair of the hernia with a mesh in the absence of appendicitis and avoiding mesh placement for hernia repair in presence of appendicular complications, seems to be a consensus seen there and again in literature review [1][2][3][4]. One study did highlight that use of mesh should not be determined by the condition of the appendix, provided intra operatively the cavity and incision site is thoroughly irrigated, drains placed and post operatively the patient remains on antibiotics [1].…”

“…One study did highlight that use of mesh should not be determined by the condition of the appendix, provided intra operatively the cavity and incision site is thoroughly irrigated, drains placed and post operatively the patient remains on antibiotics [1]. The decision ultimately will depend based on many clinical aspects being kept in mind but as a general recommendation, literature review highlighted a classification system along with management Where appendix is found to be inflamed, suppurative or perforated, a Shouldice repair is recommended based on its low recurrence rate [4]. More and more of such hernias are being managed via a laparoscopic approach, with conversion to open in the presence of complications [1].…”

Treatment dilemma in Amyand’s hernia

“…Appendix in a femoral hernia sac was first reported by De Gareneot in 1731 [2]. Appendix in an inguinal hernia, on the other hand, was first described by the British surgeon Claudius Amyand in 1735 through a case of acute appendicitis in an 11-year-old male patient [3].…”

“…Its incidence in the adult population is about 1% and it mostly manifests as an unexpected condition during surgery [1]. The rate of complicated cases is about 0.1% [2].…”