Left-Sided Amyand's Hernia Managed Without Appendectomy: A Case Report of a Rare Diagnosis

Abstract

Hernias are defined as protrusions of an organ or its fascia through the wall of a cavity. Amyand's hernia, in turn, is a rare subtype in which the vermiform appendix is part of the hernial content. We report the case of a 45-year-old Angolan patient with a large left-sided Amyand's hernia, which appeared in childhood at the age of 5, with progressive enlargement and an inability to manually reduce the contents for the past seven years. He was referred from the Hospital Militar Principal/Instituto Superior in Luanda, Angola. Large inguinoscrotal hernias remain frequent in African countries, often associated with limited access to, or late-seeking of, healthcare services. Delayed management of these patients is linked to an increased risk of preoperative complications, such as incarceration, strangulation, appendicitis, and perforation-induced peritonitis, as well as postoperative complications, including abdominal compartment syndrome. Therefore, early diagnosis and individualized patient management - considering age and comorbidities, especially in the early stages - are of utmost importance for effective and less traumatic correction.

Keywords: giant amyand's hernia; hernia repair; incarcerated inguinal hernia; position of appendix; rare form inguinal hernia.

Figure 1. Preoperative period

A large, non-reducible left inguinoscrotal hernia, extending approximately 5 cm to the anterior knee region.

Figure 2. Intraoperative findings and technique

A) Opened scrotal sac containing the small intestine (green arrow), right colon (yellow arrow), and cecal appendix (blue arrow); B) Ombredanne’s maneuver; C) Lichtenstein technique.

Figure 3. Postoperative period

The yellow arrow depicts the left hernioplasty scar.