Acute appendicitis in an incarcerated crural hernia: analysis of our experience

Abstract

Introduction: the finding of the vermiform appendix within a crural hernia (Amyand's hernia) is a rare entity whose incidence is not described in the literature. Objective: the aim of this study was to report our hospital's experience in this kind of pathology. Material and methods: between 1993 and 2004, 4,572 acute appendicitis and 372 incarcerated crural hernia cases have been operated on in our hospital. We studied 6 cases of incarcerated crural hernia with vermiform appendix inside. We analyzed in retrospect the following parameters: age, sex, personal history, clinical manifestations, preoperative diagnosis, surgical technique, mean hospital stay, and outcome. Results: all patients were women with a mean age of 78.8 years. Most frequent clinical manifestations included pain and a mass in the right inguinocrural region, of variable intensity and duration. No clinical, laboratory, or radiographic signs help in reaching a correct preoperative diagnosis. General anesthesia and a crural approach are used in most surgical operations. In all cases an appendectomy was performed via the hernia sac, thus proving the presence of acute appendicitis in four of them (66.67%). A prosthetic mesh was used in 3 cases, and one case of wound infection was found. In the other cases we sutured the hernia ring using prolene. Conclusion: the finding of the appendix in an incarcerated crural hernia is a rare entity in old women that is difficult to diagnose preoperatively. Treatment includes appendectomy and herniorraphy. The use of prosthetic mesh is controversial.

Gangrenous Amyand’s hernia in neonate: A great clinical masquerader

“…Contrary to appen- dicitis which is rare in neonates, most cases of Amyand's hernia have been reported in premature neonates, infants and postmenopausal women. Majority of cases present as obstructed or strangulated inguinal hernia and even with perforation with generalized peritonitis, systemic signs and symptoms of appendicitis are rarely evident [3][4][5]. In our case the neonate presented with features of irreducible hernia and in spite of underlying gangrene of appendix, the features of bowel strangulation were completely masked.…”

Amyand’s Hernia: A Case Report

“…5 Solecki et al observed that acute appendicitis was found in 0.62% of groin hernia sac. 6,7 Gurer et al has reported that appendix was found in 0.51 %, and acute appendicitis was found in 0.1 % of groin hernia sac. 8,9 Amyand hernia usually occurs on the right side, probably as a consequence of normal anatomic position of the appendix.…”

Amyand Hernia Repaired with Bio-A: A Case Report and Review

“…Fem- oral hernias are the second most common type, often called the DeGarengeot hernia, and they are most commonly found in postmenopausal females. 4,11 Although inflammation of the appendix in its usual anatomical position is caused by obstruction of the lumen by a fecalith, inflammation in an Amyand hernia is thought to be caused by 1 of 2 mechanisms. The first is a primary inflammatory process that causes edema to the surrounding structures, including the internal ring resulting in incarceration and obstruction.…”

“…4,5 Roughly only 0.1% of inguinal hernias contain an inflamed appendix. [6][7][8] This incidence is as high 16.6% in 1 series, including only children.…”