Amyand's hernia: A case report and review of the literature

Abstract

Introduction: An Amyand hernia is a rare disease where the appendix is found within an inguinal hernia sac. This rare entity is named after the French born English surgeon, Dr. Claudius Amyand. Inguinal hernias are one of the most common surgeries that a general surgeon performs with more than 20 million inguinal hernia repairs performed yearly worldwide. The incidence of finding an appendix within the hernia sac is rare, occurring in less than 1% of inguinal hernia patients and when complications arise such as inflammation, perforation, or abscess formation it becomes exceptionally rare with an incidence of about 0.1%.

Presentation of case: A 59-year-old male with a history of a previously reducible right inguinal hernia presented to the Emergency Department with acute abdominal pain, right groin mass. Computed tomography (CT) confirmed a right incarcerated inguinal hernia with herniated loops of bowel within the right inguinal region. Patient was subsequently treated with an appendectomy and tension free hernia repair with mesh with a successful outcome.

Discussion: The current generally accepted treatment algorithm for Amyand's hernia is essentially contingent on the appendix's condition within the hernia sac. Controversy exists regarding the application of mesh in type 2 Amyand's hernia. More research is needed to provide surgeons with evidence-based standardized approaches for dealing with this unique situation.

Conclusion: This case report reviews a rare entity known as an Amyand's hernia that presented as an incarcerated hernia that was diagnosed intraoperatively with an inflamed appendix, recognized as a type 2 Amyand's hernia.

Keywords: Acute appendicitis; Amyand hernia; Appendectomy; Appendix in hernia; Hernia repair.

Fig. 1

CT showing an incarcerated right inguinal hernia with small bowel in the right groin/hernia sac.

Fig. 2

CT showing small bowel obstruction caused by the incarcerated right inguinal hernia, with fluid filled and dilated loops of small bowel.

Fig. 3

CT showing right inguinal hernia - chronic inflammation and fibrosis at the inguinal hernia and sac.

Fig. 4

Right incarcerated inguinal hernia (Amyand type 2) – opened hernia sac with an appendix measuring 15 cm long.