Amyand’s hernia

Abstract

A 67-year old man had a large irreducible right inguino-scrotal hernia which had been enlarging for 8 years. During the last two weeks he had felt a 'dragging' pain in the right groin. He had no fever, anorexia or evidence of intestinal obstruction. The scrotum was neither tender nor tense. Surgery revealed an indirect inguinal hernial sac containing the caecum, ileum and appendix. The appendix was inflamed but not perforated. Histopathological confirmation was obtained. The appendix was covered by adjacent inflamed mesentery. The ileum was normal and devoid of a Meckel's diverticulum. After performing an a appendicectomy, the bowel was returned to the peritoneal cavity. The hernial sac was divided close to the neck and a Shouldice repair done.

Amyand’s Hernia, State of the Art and New Points of View

“…Amyand's hernias are classified according to the vermiform appendix characteristics: (type A) appendix without signs of inflammation, (type B) appendix with signs of inflammation, and (type C) perforated appendix [6, 16]. Preoperative diagnosis of AH is very difficult; in literature only one in 60 cases is diagnosed preoperatively [17]; AH diagnosis can be obtained by ultrasound (US) and/or computed tomography (CT).…”

“…US can identify an inflammatory mass in hernia sac; CT doubtlessly has more specificity and sensitivity but is usually not performed [6]. Clinical presentation changes according to AH classification.…”

Amyand’s Hernia: an Up-to-Date Review of the Literature

“…During physical examination, common findings include a painful, irreducible bulge in the groin area, accompanied with swelling of the overlying tissue and excessive redness of the overlying skin. Typically, McBurney sign is absent in those patients (23,24). Differential diagnosis should include hydrocele, testicular torsion, inguinal lymphadenitis and epidydimo-orchitis (10).…”

Treatment dilemma in Amyand’s hernia

“…It most frequently manifests as incarcerated inguinal hernia. Testicular torsion or tumor, acute hydrocele, epididymo-orchitis, scrotal abscess, inguinal lymphadenitis, Richter's hernia, strangulated hernia, and strangulated omentocele should be taken into consideration in the differential diagnosis [7,8].…”

“…Fernando and Leelaratna [7] classified Amyand's hernia as type A non-inflamed appendix, type B inflamed appendix, and type C perforated appendix. Losanoff and Basson [11], however, divided Amyand's hernia into 4 subgroups according to the inflammatory condition of the appendix within the hernia sac in their study and ascertained treatment strategies according to this classification: (1) normal appendix within a hernia sac, (2) Amyand's hernia accompanied by an inflamed appendix, (3) perforated appendix within an inguinal hernia sac, and (4) complicated intra-abdominal pathology with acute appendicitis (abscess, malignancy, etc.)…”