Amyand's hernia presented with strangulated and perforated appendicitis: A case report

Abstract

Introduction: Amyand's hernia (AH) is a rare condition in which the vermiform appendix is incarcerated within the inguinal hernia (IH) sac. Although infrequent, it may become inflamed or perforated and can typically be diagnosed either intraoperatively or through radiographic findings.

Presentation of case: A 77-year-old male presented to the emergency room with constipation, fever, and an irreducible right inguinal bulge accompanied by slight localized discomfort that had persisted for ten days. Clinical examination was unremarkable, while ultrasound revealed a non-ischemic small bowel loop and a right testicular hydrocele, leading to a primary diagnosis of incarcerated IH. The patient was subsequently admitted for surgery, during which AH was confirmed. The appendix was inflamed, enlarged, and perforated, with localized abscess and internal inguinal ring stenosis. Subsequently, the surgical treatment involved appendectomy and hernia repair.

Discussion: According to the appendix condition, four subtypes of AH can be encountered, with type III -perforated appendicitis- being the focus of this report. In this case report, inguinal ring stenosis was the underlying cause of complications besides the unusual presentation features that were also attributed to adhesions that prevented peritoneal involvement.

Conclusion: Surgeons should consider AH in the differential diagnosis of inguinal swelling and be familiar with the surgical management approach in the incidental event of AH during surgery.

Keywords: Amyand's hernia; Case report; Inguinal hernia; Perforated appendix; Strangulated appendicitis; Surgical management.

Fig. 1

Intraoperative appearance shows the appendix (a), the cecum (b), and the spermatic cord (c).

Fig. 2

Gross specimen of the strangulated, perforated, and resected appendix.