Amyand’s Hernia: A Ten-year Experience With 6 Cases

Abstract

Purpose: Amyand’s hernia is a rare hernia defined as an inguinal hernia that contains the appendix within the hernia sac. Current treatment of Amyand’s hernia remains controversial. Our study retrospectively reviewed 6 cases of Amyand’s hernia, aiming to provide a reference for the surgical treatment of Amyand's hernia.Methods: Six patients diagnosed with Amyand’s hernia from September 2010 to May 2020 were retrospectively enrolled in our study. We summarized clinical data of six patients including the chief complaint, physical examinations, laboratory examinations, imaging examinations, surgical methods, and postoperative treatments and outcomes.Results: The diagnosis of six cases with Amyand’s hernia was made during surgery. Two patients had normal appendixes whereas the remaining four patients had inflamed appendixes. Two patients with normal appendix received tension-free mesh repair through the inguinal incision. Among those with inflamed or perforated appendixes, two received mesh repair and the other two did not. The discharge time after surgery of six patients was 9.8±6.1 days. One patient suffered from an incision infection. No additional postoperative complications were detected. Conclusions: Computed tomography and ultrasonography are helpful but limited in the definite diagnosis of Amyand’s hernia. The presence of a normal appendix does not require to be resected, but appendicectomy is necessary if the appendix is inflamed. The treatment of Amyand's hernia should be tailored based on the patient's condition and the type of Amyand's hernia.

Amyand hernia as a rare cause of abdominal pain: A case report and literature review

“…In case of infection and peritonitis, mesh repair should be avoided. 12,18 Although current surgical procedures for AH type 2 hernias are under the influence of new prosthetic materials like biological mesh which prevents recurrence, there is not enough research to support this claim. 19 Despite the high index of clinical suspicion during the surgery, the decision to perform an appendectomy or use a mesh to repair a hernia should always be individualized, since it depends on the patient's condition such as appendix inflammation level, surgery and cavity contamination grade, age, comorbidities, and hernia type.…”

“…It may be found incidentally during an elective surgery without any signs or symptoms or manifested by acute appendicitis with perforation and abscesses along with an incarcerated hernia. Although WBC and CRP can help us differentiate the inflamed appendix from the healthy one, 3,12 typical epigastric or periumbilical pain that is limited to the RLQ of the abdomen is the most important symptom of AH. This situation would be presented with a compressible mass in the inguinal or inguinoscrotal area 13 .…”

“…The sonographer should use a high‐frequency linear array transducer to observe the inguinal canal if AH is a possibility. Although, imaging of any components found in the hernia sac to investigate a non‐irreducible tubular structure must be considered, 4,8,14 final and certain diagnosis will be made by laparoscopy during surgery 12 . As a result, surgery often serves both diagnostic and therapeutic purposes.…”

“…Using mesh repair required precision. In case of infection and peritonitis, mesh repair should be avoided 12,18 . Although current surgical procedures for AH type 2 hernias are under the influence of new prosthetic materials like biological mesh which prevents recurrence, there is not enough research to support this claim 19…”

“…Although, imaging of any components found in the hernia sac to investigate a non‐irreducible tubular structure must be considered, 4 , 8 , 14 final and certain diagnosis will be made by laparoscopy during surgery. 12 As a result, surgery often serves both diagnostic and therapeutic purposes. Since the appendix might be non‐inflamed when found inside the inguinal hernia sac, appendectomy is not required all the time.…”