Amyand's Hernia With Retractile Testis and a Normal Appendix: Is Appendectomy Truly Required?

Abstract

An inguinal hernia is a common surgical condition in which abdominal contents protrude through the lower abdominal wall into the inguinal canal. The hernia sac can contain various structures, including the appendix, which, when present, is referred to as Amyand's hernia. The condition is rare, with a normal appendix found in less than 1% of inguinal hernias. This condition was first described by Claudius Amyand in 1735. The coexistence of the appendix and a testis (either undescended or retractile) within the hernia sac is a rare phenomenon, adding to the complexity of diagnosis and management. In this report, we have a one-year-old male infant presenting with a right-sided irreducible inguinal hernia associated with swelling and pain for four hours. Physical examination and ultrasound suggested an irreducible hernia with omentum as the content, but without evidence of appendix or testis involvement. On surgical exploration, a normal appendix and a retractile right testis were found within the hernial sac. The hernia contents were reduced, and a right inguinal herniotomy was performed. Intraoperative and postoperative periods were uneventful. The patient was discharged after three days and had an unremarkable follow-up. Amyand's hernia is an uncommon condition in which the appendix is located within the inguinal hernia sac. The presence of both the appendix and a testis in the same sac is even rarer. Our case differs from the classic presentation of Amyand's triad, as it involves a retractile testis and a normal appendix. This highlights the need for thorough clinical evaluation and tailored treatment based on individual findings. Surgeons should be aware of the varied presentations of this condition and the recommended management strategies to provide optimal care.

Keywords: amyand’s hernia; appendicitis; case report; inguinal hernia; pediatric surgery; retractile testis.

Figure 1. Clinical photo at the time of presentation

The arrow indicates the site of swelling.

Figure 2. Ultrasound of the right inguinoscrotal region

The arrow shows the defect in the deep inguinal ring.

Figure 3. Intraoperative photo showing the appendix (shown by the arrow)

Figure 4. Intraoperative photo showing the testis

The arrow shows the right testes in the right inguinal region.