Amyand’s hernia presenting as an unusual inguinal mass: a case report

Abstract

Accounting for approximately 0.4-0.6% of all inguinal hernias, Amyand's hernia is a rare condition in which a vermiform appendix is found in an inguinal hernia sac. It is most commonly found in males and in the pediatric population. Since Claudius Amyand's first reported case in 1736, there have only been a total of 228 documented cases of the Amyand's hernia. Due to its rarity, the pathophysiology and risk factors of the condition are still unclear. Some theorize that it is secondary to a patent processus vaginalis or perhaps the presence of a fibrous band between the hernia sac and testes. Amyand's hernia usually presents as an incarcerated or strangulated hernia, but its presentation can be quite variable. We report an unusual case of an Amyand's hernia presenting as an enlarging painful mass on the right lateral edge of the mons pubis, resembling an abscess.

Our experience with Amyand’s hernia

“…In terms of the cases reported in the literature thus far, the age of patients who have had an AH varies greatly, but is commonly found in males and in paediatric population (due to the presence of patent processus vaginilis). 2 Our study also corroborates with literature in terms of age and sex.…”

“…An AH is an inguinal hernia which contains whole or part of appendix in the sac. 2 This is a rarely encountered entity and accounts for approximately 1% of all inguinal hernias, with some reports stating incidence to be as low as 0.04 to 0.06%. 2 The incidence becomes even lower when appendix is pathological, i.e., inflamed (0.07-0.13%) or complicated by perforation and abscess formation (0.1%).…”

“…2 This is a rarely encountered entity and accounts for approximately 1% of all inguinal hernias, with some reports stating incidence to be as low as 0.04 to 0.06%. 2 The incidence becomes even lower when appendix is pathological, i.e., inflamed (0.07-0.13%) or complicated by perforation and abscess formation (0.1%). 1 Appendix has been known to protrude into the inguinal AH and femoral (De Garengeot's hernia) hernia sacs; and less commonly, into obturator hernia, umbilical hernia, Spigelian hernia, laparoscopic port site hernia, drain site hernia, incisional hernia and diaphragmatic hernia.…”

“…1 An AH is characterised by whole or part of appendix as content of an inguinal hernia; the appendix itself may be normal, inflamed or exhibiting any other pathology. 2 The reported incidence of AH is as low as 1% and complication with acute appendicitis is reported in only 0.08-0.13% of cases. 3 A perforated appendix in an inguinal hernia sac is even rarer.…”

“…3 Because of the rarity of this type of hernia and only scattered case reports published in literature, the pathophysiology of this condition is enigmatic and a standard management approach has not yet been established. 2 We describe our experience with AH over a 2-year period at our institute. A brief review and discussion of literature of this rare hernia follows.…”