Amyand’s Hernia With Concurrent Appendicitis: A Case Report and Review of the Literature

Abstract

Amyand's hernia is defined as an inguinal hernia which contains the vermiform appendix. This continues to pose a diagnostic and therapeutic challenge. We herein describe the case of an 11-year-old male with a right-sided Amyand's hernia and concurrent appendicitis. A literature review was also conducted, looking at history, aetiopathogenesis, symptomatology, and management. This case highlights the difficulty clinicians can have in reaching a preoperative diagnosis of Amyand's hernia and selecting the appropriate surgical management.

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

“…AH is a condition in which the vermiform appendix is contained within the inguinal hernia sac [ 7 ]. The pathogenesis of developing appendicitis in AH is not well understood.…”

“…The pathogenesis of developing appendicitis in AH is not well understood. It is unclear whether the presence of the appendix within the hernial sac is responsible for the development of appendicitis, or whether appendicitis occurs coincidentally within the sac [ 7 ]. The proposed theories have been reviewed [ 7 ], and include: (1) incarceration and subsequent appendiceal inflammation; (2) development of adhesions between the hernia sac and appendix, resulting in irreducible hernia; (3) abdominal muscle contraction increasing intra-abdominal pressure leading to compression and obstruction of the appendix; and (4) primary appendicitis leading to an irreducible hernia from venous stasis and impaired microcirculation within the appendix.…”

“…AH is difficult to diagnose preoperatively and a definitive diagnosis is often made during surgery [ 7 , 8 ]. Symptomatic AH presents clinical features resembling those of an incarcerated or strangulated hernia.…”

Hidden Treasure: Congenital Adhesions Necessitating an Alternative Approach to Laparoscopic Appendicectomy

“…Interestingly, there have been other cases reported where an inflamed appendix was found in unusual spaces in the abdomen, leading to unremarkable changes in inflammatory markers. Probert et al describe a case of appendicitis in an Amyand hernia in which the patient had down-trending inflammatory markers without treatment [ 6 ]. Sigley et al also describe a case of appendicitis in an umbilical hernia where the inflammatory markers were also normal [ 7 ].…”

A Case of Amyand’s Hernia Variant

“…It deals with situations when there is an incisional hernia; in these situations, the appendix is addressed as type I; acute appendicitis is managed by appendectomy through the hernia and subsequently followed by hernia repair with primary closure; and peritonitis with sepsis is managed as type IV. 13…”