Amyand’s Hernia: A Case Report

Posted By Haris Shekhani
Amyand’s Hernia: A Case Report

Amyand’s Hernia: A Case Report ABSTRACT: Amyand’s hernia is a rare and atypical hernia characterized by the herniation of the appendix into the inguinal sac. This hernia may be present without symptoms until inflammation of the appendix leads to incarceration, strangulation, necrosis, perforation or rupture. Early symptoms include tenderness and inguinal swelling which may be misdiagnosed as a strangulated hernia. This condition can be difficult to diagnose clinically. Ultrasound and Computed Tomography may aid in diagnosis. This article presents a rare case of Amyand’s hernia followed by a discussion of the epidemiology, diagnosis, imaging details and treatment options for this condition. CASE REPORT: A 47-year-old male was admitted to a trauma service with history of a ground level fall at work. Computed tomography (CT) showed bilateral inguinal hernias with small bowel obstruction. A normal appearing appendix was noted extending into the right inguinal canal. The patient was initially managed non-operatively, but was subsequently taken for exploratory laparotomy due to failure of conservative management. Operatively, there was chronic scarring and adhesion formation in the right lower quadrant, presumably from chronic incarceration within the right inguinal hernia. Lysis of adhesions was performed around the cicatrix of the distal ileum just proximal to ileo-cecal valve. On the left, sigmoid colon was reduced from the left inguinal hernia. DISCUSSION HISTORY: The rare presence of the appendix in an inguinal hernia sac is known as Amyand’s hernia [1-6]. This condition was first described and treated in 1735 by Claudius Amyand [1-5, 7-9]. It is most often found incidentally during hernia repair surgery [2]. Amyand’s hernia accounts for between 0.4 and 1% of all inguinal hernias, and appendicitis in conjunction with Amyand’s hernia accounts for 0.1% of all cases of appendicitis [3, 4]. 11% occur in patients with Meckel’s diverticulum [2] and is three times more common in the pediatric population, due to the patency of the processus vaginalis [10]. In the pediatric population, the prevalence is 1% and occurs more often in males than females [2, 3]. Amyand’s hernia typically presents on the right side. This is likely due to the normal anatomic position of the appendix [4, 7]. Although it is rare, left sided Amyand’s hernias do occur and have thought to be the result of a mobile or floppy cecum, intestinal malrotation or situs inversus [1-3, 10]. The pathophysiology of Amyand’s hernia is uncertain, though theories proposed include an accidental herniation of the appendix, a congenital laxity of the right colon or some factor of both [7]. Michalinos et al. points to a congenital factor, noting that Amyand’s hernia has been seen in neonates and a set of premature twins [3]. It is also unclear if there is a causal relationship between the herniation of the appendix and the appendicitis. Most investigators believe infla

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