Amyand's hernia a case report

Abstract

Introduction and importance Amyand's hernia (AH) is a form of inguinal hernia which is consider as very rare and this type of hernia occurred up to 1% of all inguinal hernia cases. In this type of inguinal hernia, the content of hernia sac is appendix. Most patient with AH often remains asymptomatic and diagnosed intraoperatively. The diagnosis is challenging, since needs a high index of suspicion and imaging is key. Surgery is the mainstay management. We report a case of Amyand's hernia that was managed operatively in our medium complex public institution. Case presentation A 28 year's old man with normal body mass index (BMI) who had a history of right-side reducible linguino-scrotal swelling for 8 years, was admitted for elective right inguinal hernia repair. Two weeks back before admission, he noticed that swelling was slightly painful. Ultrasound of the abdomen reported normal findings. There was no history of abdominal pain and vomiting. Laboratory parameters were within normal limit. So, with a diagnosis of right sided partially reducible, incomplete, and indirect inguinal hernia, patient was operated for open hernia repair surgery, intra operatively we found dense adhesions within the sac, adhesions were released which revealed herniation of appendix into the inguinal canal. Appendix was mildly congested without gross evidence of inflammation. Hence, in view of noninflamed appendix, preperitoneal mesh (polypropylene) hernioplasty from Lichtenstein tension-free mesh repair was performed with appendicectomy. Postoperative period was uneventful, patient discharged at second day. Clinical discussion Amyand's hernia is very uncommon and characterized by the presence of the appendix in the hernia sac and it is 0.4–1% of all inguinal hernia cases, literature review also showed that incidence of Amyand's hernia is very rare, whereas only 0.1% of cases complicate into acute appendicitis due to late presentation and missed diagnosis. Conclusion Amyand's hernia (AH) makes up only a small proportion of most inguinal hernia cases, and its diagnosis is usually based on incidental finding intra-operatively. This condition may remain asymptomatic and behave like a normal inguinal hernia. Management of this type of hernia should be individualized according to appendix's inflammation stage, presence of abdominal sepsis and co-morbidity. With this approach it enables surgeons to manage more variations of Amyand's hernia. Laparoscopy for dealing Amyand's hernia is frequently diagnostic as well as therapeutic.

Combinación de técnicas quirúrgicas en la hernia gigante de Amyand irreductible

“…En la HA tipo 1 se realiza hernioplastia y la apendicectomía solo la recomiendan en pacientes jóvenes o niños 12 . En el resto de las edades la apendicectomía es un procedimiento factible, siempre que se evite el derrame fecal, para que la malla implantada resulte segura 11,16 . Otros autores también realizan apendicectomía, cuando existe riesgo de adquirir apendicitis aguda por la manipulación, al existir adherencias entre el apéndice y el saco herniario 16 .…”

“…En la HA tipo 2 se realiza herniorrafía y apendicectomía por vía inguinal 12,16 . Si el campo quirúrgico está relativamente limpio se justifica el uso de malla protésica, de lo contrario la hernia se repararía utilizando los tejidos endógenos 11,16,19 . En las guías WSES otorga una alta recomendación al uso de malla sintética en hernias con heridas limpias-contaminadas 16 .…”

Appendix Playing Hide and Seek: A Variation to Amyand’s Hernia

“…Most surgeons agree that synthetic meshes or plugs should not be used in cases of acute appendicitis (Losanoff-Basson types 2-4) within a hernia. However, there is a difference of opinion regarding the need for an appendectomy in cases of type 1 Amyand's hernia with a normal appendix within the inguinal hernia [ 6 ]. If an appendix appears normal within a hernia, it may not always need to be removed through an appendectomy.…”

Amyand’s Hernia: a case report

“…El tratamiento definitivo y curativo en esta patología es quirúrgico. Existe controversia entre realizar una apendicectomia en el caso de no presentar signos de inflamación (6)(7)(8) ; algunos autores recomiendan no realizar una apendicectomía cuando no hay evidencia de apendicitis aguda, por lo tanto, si en el transoperatorio existen datos clínicos de apendicitis o perforación, la apendicectomía debe ser realizada, con la reparación adecuada del defecto de la hernia (4)(5) .…”

“…El uso de malla también es controvertido, ya que algunos autores sugieren que hay más riesgos de infección por contaminación de la pared abdominal cuando se ha producido una perforación del apéndice (7)(8)(9) .…”