An elective detection of an Amyand's hernia with an adhesive caecum to the sac: Report of a rare case

Abstract

Context: Existence of non-inflamed or inflamed vermiform appendix in an inguinal hernia is named Amyand's hernia in honor to the surgeon Claudius Amyand who successfully performed first perforated appendicitis.

Case report: A 69-year-old Turkish male patient with a slight right groin pain and swelling was presented to our clinic, and found to have a slightly tender and reducible right inguinal hernia. He underwent surgery under general anesthesia, and a adhesive caecum and an inflamed appendix were explored within the hernia sac. Adhesions were divided by sharp dissection and appendectomy was performed. After carrying out a Lichtenstein hernioplasty, a broad-spectrum antibiotic was postoperatively admitted for 3 days. He recovered uneventfully, and neither complication nor recurrence was detected during 52 months of follow-up.

Conclusions: Although occurrence of an appendicitis in an inguinal hernia is rare, a surgeon should be vigilant for facing with it even in elective cases. Treatment can be provided only surgically, but surgical treatment is not standard except from appendectomy. In our opinion, application of mesh hernia repair should depend on the degree of inflammation of appendix and the presence of incarceration of hernia sac with a suitable antibiotic admission for 3-5 days postoperatively.

Keywords: Hernia; appendicitis; inguinal.

Fig. 1

A drawn image of an adhesive caecum and an inflamed appendix with an appendiceal fecalith within the sac of right inguinal hernia after splitting the sac perioperatively.

Fig. 2

Although mucosal and submucosal part was in normal histological appearance, congestion and focal lenfocytic infiltration was seen in serosal portion of the appendix (Haematoxylin & Eosin, Original magnification, 100×).