Atypical Appendicitis in the Elderly

Abstract

Amyand's hernia is an extremely rare condition in which the appendix is positioned in the inguinal hernia sac. Acute appendicitis is much less common in this situation, especially in the elderly population, and few reports are found in the literature. Whether the presence of the appendix within the inguinal sac increases the chance of developing appendicitis or the relationship is coincidental is unclear. Majority of cases reported are in the male pediatric population. The varying surgical approaches are entirely case-specific without much standardization. Perioperative planning remains difficult in all cases as this condition is exceedingly rare, especially outside of the pediatric population. We present such a case with the hope that we increase awareness about this uncommon condition, in which preoperative diagnosis and planning remains difficult.

Keywords: amyands hernia; appendicitis; elderly individuals; hernia; hernia in elderly.

Figure 1. Computed tomography (CT) scan done at the time demonstrated a large left-sided hernia containing the sigmoid colon without evidence of stranding, inflammation, or obstruction. The right side was also noted to have a large hernia with the cecum and appendix in the sac associated with stranding and some pericolonic fluid collection.