Review Article: Appendicitis In Groin Hernias

Abstract

To review the clinical presentation, outcome and causes of acute appendicitis presenting within a groin hernia. A comprehensive review of the past 70 years of English language surgical literature was conducted pertaining to acute appendicitis presenting within an inguinal or femoral hernia. Thirty-four reports describing 45 patients were reviewed to determine age, position, gender, pathologic stage at presentation, causal suppositions, and clinical outcomes. Hernial appendicitis presented as an inguinal abscess or a tender inguinal mass, often in the femoral position, and most commonly at the extremes of age. It was almost never recognized preoperatively, and, because of the sequestered nature of the inflammatory process, presented with few classic systemic signs or symptoms suggestive of acute appendicitis. Advanced pathologic stage and death correlated with the patient's age, delay in presentation, and delay in recognition. Evaluation of an inguinal abscess or a nonreducible tender groin hernia presenting in a patient at the extremes of age, should include computed tomography to rule out an occult acute appendicitis within the hernia, as systemic signs and symptoms of appendicitis are rarely evident. The condition appears to be caused by inflammatory adhesions caused by appendicitis occurring within an enlarged hernial orifice rather than appendicitis caused by external compression of the appendix base. Early recognition of this unique presentation of appendicitis allows trans-hernial appendectomy and immediate herniorraphy. Delayed diagnosis requires drainage of abscess with appendectomy and interval hernia repair.

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

“…Computer Tomography with Multi Planar Reconstruction is the most useful technique, to better visualize the appendix and its relationship with surrounding structures, thus aiding in confidently making the correct diagnosis pre-operatively [7]. Management depends on the state of the appendix, majority of authors agree that a normal appendix within the hernial sac does not require appendectomy [8,9]. In neonates with underlying appendicitis, herniotomy and appendicectomy should be performed [9,10].…”

“…Management depends on the state of the appendix, majority of authors agree that a normal appendix within the hernial sac does not require appendectomy [8,9]. In neonates with underlying appendicitis, herniotomy and appendicectomy should be performed [9,10]. In adults the repair of the hernia should be performed with Bassini or Shouldice techniques, without making use of synthetic meshes or plugs within the defect due to the high risk of suppuration of such materials [10].…”

Abscess in the inguinal hernial sac after peritonitis surgery: A case report

“…Several cases of abscess in the hernial sac caused by acute appendicitis or by strangulation and perforation of the intestines in the hernial sac have been reported [2,3] . The protrusion of a vermiform appendix into the inguinal hernial sac, termed an Amyand hernia, and into the femoral hernial sac is termed a De Garengeot hernia [4,5] .…”

“…The protrusion of a vermiform appendix into the inguinal hernial sac, termed an Amyand hernia, and into the femoral hernial sac is termed a De Garengeot hernia [4,5] . When acute appendicitis occurs in the hernial sac, it may lead to the development of a hernial sac abscess [3] . However, our review of the literature revealed that, after cases of abscess in the hernial sac secondary to peritonitis were reported by Cronin and Ellis in 1959 and Chary in 1977 [1,6] , few other such cases have been reported.…”

The role of prosthetic repair in the treatment of an incarcerated recurrent inguinal hernia with acute appendicitis (inflamed Amyand’s hernia)

“…Most of them are present in an Amyand's hernia, as it is an entity which aVects mainly older patients with a median peak age of 69 years [5].…”