Strangulated Amyand's hernia with testicular necrosis in an adult: A case report

Abstract

Introduction: Amyand's hernia is a rare condition defined by the presence of the vermiform appendix within an inguinal hernia sac. The occurrence of Amyand's hernia with testicular necrosis is particularly uncommon, further complicating its clinical presentation and management.

Case presentation: A 50-year-old male presented with a two-year history of progressive right scrotal swelling, acutely worsened over four days with pain and fever. Examination revealed a firm, tender, irreducible right scrotal mass with overlying erythema. Laboratory tests showed leukocytosis. Imaging confirmed an inflamed appendix within the hernial sac, consistent with Amyand's hernia complicated by abscess formation. Emergency surgery revealed a gangrenous appendix, scrotal abscess, and necrotic right testicular tissue. The patient underwent appendectomy, orchiectomy, hernia repair, and abscess drainage. He recovered uneventfully, with symptom resolution and no recurrence at follow-up.

Discussion: The progression of Amyand's hernia to appendicitis and subsequent perforation, as seen in our case, can result in severe complications, including abscess formation and testicular necrosis. The Losanoff and Basson classification categorizes Amyand's hernia based on the appendix's condition and associated complications, ranging from a normal appendix (Type 1) to severe extra-sac pathology such as gangrene or malignancy (Type 4). Our case aligns with Type 4, involving a perforated appendix with gangrene and a scrotal abscess, necessitating extensive surgical intervention.

Conclusion: This case highlights the rarity and complexity of Amyand's hernia in adults, emphasizing the need for prompt recognition and tailored management to achieve favorable outcomes.

Keywords: Amyand's hernia; Appendix; Case report; Strangulated; Testicular necrosis.

Fig. 1

The white arrow indicates the scrotum. The green arrow shows necrotic tissue within the scrotum. The blue arrow points to the tip of the appendix. The yellow arrow points to the cecum. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

The yellow arrow indicates the mesoappendix, while the green arrow points to the cecum. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

The yellow arrow represents the cecum, the blue arrow indicates the base of the appendix, and the green arrow marks the tip of the appendix. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)