Acute appendicitis in Amyand’s hernia: ultrasound findings and histopathology correlation. A case report

Abstract

Amyand’s hernia is an uncommon form of inguinal hernia. It represents <1% of all hernias and its complication with appendicitis is still rarer with 0.1–0.13% being reported. A 78-year-old woman was taken to the emergency room with pain in the right groin. The patient was assessed by ultrasound with the clinical suspicion of an inguinal hernia. We present the ultrasonographic features of appendicitis within an inguinal hernia sac. A tubular image that terminated in a blind-ended tip in the longitudinal plane and a target image on the cross-sectional plane were consistent with the sonographically demonstrated appendix. The diagnosis of Amyand’s hernia is difficult in the clinical setting. The patient is frequently referred to surgery with the diagnosis of an incarcerated hernia. Ultrasound is a good imaging modality that detects and characterizes this uncommon condition.

Amyand Hernia

“…Other case reports demonstrate that Amyand hernia complicated by appendicitis could be diagnosed on RADUS. 7,8 These reports noted the presence of a blind ending tubular structure present in the scrotum that measured >6 mm in diameter with associated inflammatory changes and free fluid, consistent with the diagnosis of appendicitis. However, there are no reports to date of Amyand hernia with or without appendicitis recognized on POCUS (Supplemental Digital Content, Supplementary Video 1, http://links.lww.com/PEC/A806).…”

“…The first report of preoperative sonographic diagnosis was by Akfirat et al, 6 in which a 2-month-old male infant was diagnosed with a reducible hernia and a sliding appendix in the right inguinal sac. Other case reports demonstrate that Amyand hernia complicated by appendicitis could be diagnosed on RADUS 7,8 . These reports noted the presence of a blind ending tubular structure present in the scrotum that measured >6 mm in diameter with associated inflammatory changes and free fluid, consistent with the diagnosis of appendicitis.…”

“…There are several case reports diagnosing Amyand hernia on RADUS. [6][7][8][9][10] The first report of preoperative sonographic diagnosis was by Akfirat et al, 6 in which a 2-month-old male infant was diagnosed with a reducible hernia and a sliding appendix in the right inguinal sac. Other case reports demonstrate that Amyand hernia complicated by appendicitis could be diagnosed on RADUS.…”

“…Ultrasound is a dynamic study that offers potential for rapid and accurate diagnosis of this disorder. There are several case reports diagnosing Amyand hernia on RADUS 6–10 . The first report of preoperative sonographic diagnosis was by Akfirat et al, 6 in which a 2-month-old male infant was diagnosed with a reducible hernia and a sliding appendix in the right inguinal sac.…”

A case report of Amyand hernia—radiological diagnosis and literature review

“…Imaging plays an important role in diagnosing Amyand hernia. The ultrasound features of Amyand hernia are the presence of a non-compressible, dilated, blind-ending bowel loop with a luminal diameter of more than 7.2 mm, within the inguinal canal with or without surrounding inflammation [11]. In CT, signs of Amyand hernia are the presence of an appendix within the inguinal canal with or without inflammation.…”