Amyand’s hernia: history, imaging, and management

Milanchi, Siamak; Allins, Alexander D.

doi:10.1007/s10029-007-0304-6

Cited by 68 publications

(61 citation statements)

References 4 publications

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“…In 1735, Amyand operated on an 11-year-old boy whose inguinal hernia encompassed an inflamed appendix [1]. Of all incarcerated hernias, it has been estimated that only 1 % contain a normal appendix, and most present as did our case with a strangulated right-sided inguinal hernia [1,2]. Even more rare is the presence of appendicitis within the hernia sac at 0.13 % [1].…”

Section: Discussionmentioning

confidence: 94%

A case of appendicocele

Davis

Privette

2012

Intern Emerg Med

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A 58-year-old woman with an unconfirmed diagnosis of uterine fibroids, and a past medical history of uterine polyps, two cesarean sections and a right inguinal herniorraphy presented to the emergency department with 1 month of sharp right lower quadrant pain that had become debilitating 24 h prior to presentation. She also complained of vaginal discharge and bleeding while denying nausea, vomiting and fever. Physical examination revealed a mass in the right inguinal area that was exquisitely tender to palpation and irreducible at the bedside. Her symptoms were exacerbated with a valsalva maneuver. Bowel sounds were present in all four quadrants. Laboratory findings were all within normal limits. She remained afebrile. The patient had an abdominal/ pelvic MRI earlier that day at an outlying facility ordered by her gynecologist. Unfortunately, the results were not available at the time the patient presented. On further consultation, recommendations were made for outpatient follow up. Given the patient's presentation, undifferentiated gynecologic pathology and history of multiple abdominal surgeries, further evaluation was warranted to solidify the diagnosis, and to confirm the need for surgical intervention for the most likely diagnosis of an incarcerated inguinal hernia. Computed tomography (CT) of the abdomen revealed a fibroid uterus, focal lesions in the urinary bladder and right indirect inguinal hernia containing the appendix with mild stranding and thickening of the hernia sac wall concerning for acute appendicitis (Figs. 1, 2 and 3). The appendix measured 7.0 cm in length and 0.7 cm in diameter on pathologic evaluation. DiscussionAn inguinal hernia containing a vermiform appendix is known as an appendicocele. Claudius Amyand is noted as the first surgeon to perform a successful appendectomy and herniorraphy in an appendicocele. In 1735, Amyand operated on an 11-year-old boy whose inguinal hernia encompassed an inflamed appendix [1]. Of all incarcerated hernias, it has been estimated that only 1 % contain a normal appendix, and most present as did our case with a strangulated right-sided inguinal hernia [1,2]. Even more rare is the presence of appendicitis within the hernia sac at 0.13 % [1]. Pain is often described as crampy, achy or burning with tenderness to palpation over the inguinal region [4]. Plain radiographs are of little help unlike ultrasound or CT scans that assist in the diagnosis [3]. In one report studying appendicoceles in adults, this rare condition was more common in men than women with a median age of 42 years [3]. The treatment of choice for appendicocele is appendectomy through a herniotomy incision followed by herniorraphy [4]. The use of prosthetic material is not advised with evidence of inflammation [3].Our patient, within 4 h of diagnosis, was treated preoperatively with intravenous antibiotics followed by open appendectomy and inguinal hernia repair, without the use of prosthetic material.

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Section: Discussionmentioning

confidence: 94%

A case of appendicocele

Davis

Privette

2012

Intern Emerg Med

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“…Acute appendicitis in an inguinal hernia sac was referred as Amyand's hernia to honour Claudius Amyand, who was the first who described the presence of a perforated appendix within the inguinal hernial sac in 1735 (1)(2)(3)(4)(5)(6)(7). Investigation of anatomic and pathological features of this rare entity in forensic autopsy is important determinants for scientific classification, description also correct pre-postoperative managements and appropriate surgery.…”

Section: Introductionmentioning

confidence: 99%

Amyand's Hernia in Forensic Autopsy: Case Report and Review of the Literature

Türkmen¹,

Eren²,

Dokgöz³

2013

Med Arh

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T he presence of vermiform appendix in inguinal hernia is rare and is known as Amyand' s hernia. Reported case was 73 years old man admitted to the hospital with chest pain who dead soon after admittance in the emergency department of the university hospital. In the macroscopic autopsy investigation, after opening the hernial sac, the vermiform appendix and caecum were detected free, without adhesions in the hernial sac. Death was reported due to acute myocardial infarction. Investigation of this rare entity in forensic autopsy is important for scientific classification, description and also correct pre-postoperative management and appropriate surgery.

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“…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]. It has maintained its position as a rare case with its incidence of 1% since then [4].…”

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confidence: 99%

“…Güler et al [9] also recently reported 2 cases diagnosed preoperatively by ultrasonography. Abdominal CT is not suggested for all cases of incarcerated inguinal hernia in order to diagnose Amyand's hernia preoperatively, but it should be preferred in selected cases with findings suggesting acute appendicitis alongside incarceration [3]. Diagnostically fever and leukocytosis are not very common [10].…”

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confidence: 99%

“…When studies in the literature were investigated in order to find out whether mesh should be used in the presence of an inflamed appendix, it was found that there was no consensus on the subject. The general perspective is to prefer hernia repair without mesh (Shouldice, Bassini) because of the contamination of the surgical field with infection, sepsis, fistula, and increased risk of hernia recurrence, as appendectomy is inevitable from type 2 and above [3,6,8,11]. Torino et al [12], on the other hand, placed mesh without any complications in a case with perforated appendix.…”

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confidence: 99%

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