Laparoscopic repair of Amyand's hernia complicated with acute appendicitis. Report of a case

Abstract

The presence of vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. Amyand's hernia complicated with acute appendicitis is an extremely rare entity with challenging diagnosis and large debate about the optimal treatment option. We report a case of a 58-year-old man presenting to the Emergency Department with an incarcerated right inguinal hernia. At laparoscopy, an inflamed appendix was identified within the inguinal canal, representing an indirect Amyand's hernia. A laparoscopic appendicectomy was performed followed by a trans-abdominal pre-peritoneal mesh repair of the aforementioned hernia. We report this rare clinical entity raising physicians' awareness to include acute appendicitis within an Amyand's hernia in the differential diagnosis of incarcerated inguinal hernias, along with a successful minimally invasive surgical approach.

Figure 1:

Sliding indirect right inguinal hernia during laparoscopy with vermiform appendix as content of the sac (Amyand’s hernia).

Figure 2:

Inflamed vermiform appendix as content of the sac.

Figure 3:

Hernia’s orifice after reversal of the sac’s content.

Figure 4:

Laparocopic mesh placement.