Complicated acute appendicitis within a right inguinal hernia sac (Amyand's hernia): report of a case

Abstract

Background: The term Amyand's hernia refers to a rare clinical situation characterized by the presence of a normal or inflammed appendix within the sac of an inguinal hernia. The situation may be asymptomatic or may present as an incarcerated hernia in case of strangulation or acute appendicitis occurring inside the hernia sac.

Description of the case: We present the case of a right Amyand's hernia on a 88-years-old male that presented to our emergency department with a severely tender and swollen inguinal mass that was diagnosed as a strangulated inguinal hernia - inguinal abcess and underwent emergency operation. The intraoperative findings included a severely inflamed and perforated appendix along with healthy part of the caecum inside the sac. Appendectomy with subsequent primary hernia repair without mesh was performed with excellent outcome.

Conclusion: Because of the fact that most of such rare cases are managed by urgent surgery with no preoperative diagnosis, every surgeon should be prepared for the possibility of coping with such an unexpected situation.

Keywords: Inguinal hernia; appendicitis; appendix; hernia mesh.

Figure 1. Microphotograph (Hematoxylin & Eosin, x 200) showing the inflamed appendix (on the right) next to vascular, connective and adipose tissue of spermatic cord and omentum (on the left).