Incarcerated recurrent Amyand′s hernia

Abstract

Amyand's hernia is a rarity and a recurrent case is extremely rare. A 71-year-old male with a previous history of right inguinal hernia repair presented to the emergency department with a 1-day history of pain in the right groin. A physical examination revealed a nonreducible right inguinal hernia. A computed tomography scan showed a 1.3-cm appendix with surrounding inflammation within a right inguinal hernia. An emergent right groin exploration revealed an incarcerated and injected non-perforated appendix and an indirect hernia. Appendectomy was performed through the groin incision, and the indirect hernia defect was repaired with a biological mesh (Flex-HD). We hereby present this unique case – the first reported case of recurrent Amyand's hernia and a literature review of this anatomical curiosity.

Amyand’s Hernia: an Up-to-Date Review of the Literature

“…In very rare cases, incarceration and obstruction of the appendix may be induced, resulting in acute appendicitis (18,19). Given that the inflamed appendix is contained within the hernia sac, the symptoms of the appendicitis, in this case, are those of an irreducible or incarcerated inguinal hernia or, occasionally, of an acute scrotum ipsilaterally with the inguinal hernia, with accompaning symptoms such as pain in the right lower quadrant of the abdomen, anorexia, nausea and vomiting (20,21,22). During physical examination, common findings include a painful, irreducible bulge in the groin area, accompanied with swelling of the overlying tissue and excessive redness of the overlying skin.…”

“…Okur et al studied 21 Amyand's hernia cases, performing a preoperative ultrasound in 12/21 cases (57.1%) and diagnosing the hernia in 9/12 (75%) of them (11).…”

Treatment dilemma in Amyand’s hernia

“…Amyand's hernia is observed in males and on the right more often, and those occurring on the left are observed in cases of situs inversus, mobile cecum, and intestinal malrotation [4]. The detection of Amyand's hernia beforehand is rare and it is generally ascertained randomly during a surgical procedure [4,6]. Its clinical presentation varies depending on the presence or absence of periappendicular inflammation and also peritoneal contamination and is in the form of epigastric, periumbilical pain, or pain in the lower right quadrant, and irreducible inguinal mass.…”

“…Appendix in an inguinal hernia, on the other hand, was first described by the British surgeon Claudius Amyand in 1735 through a case of acute appendicitis in an 11-year-old male patient [3]. It has maintained its position as a rare case with its incidence of 1% since then [4].…”

“…Amyand's hernia is observed in males and on the right more often, and those occurring on the left are observed in cases of situs inversus, mobile cecum, and intestinal malrotation [4]. The detection of Amyand's hernia beforehand is rare and it is generally ascertained randomly during a surgical procedure [4,6].…”