A male patient with amyand hernia: A case report and literature review

An Amyand hernia is a protrusion of an organ or its fascia through the wall of the abdominal cavity which contains the appendix, which has an incidence rate of 0.5–1% of the many hernia cases. This review reports the case findings of a 63-year-old male patient with an inguinal hernia containing the appendix (Amyand hernia). The patient came with complaints of abdominal pain and a lump in his testicles, with a history of frequent lumps coming and going. Physical examination from the right inguinal to the scrotal sac found a lump the size of three adult fists with the same skin color as the surroundings. The patient was diagnosed with a giant right scrotal hernia and underwent herniorrhaphy surgery and mesh placement. During the operation, the appendix and mesoappendix were visible upon opening the hernia sac, so it was decided to perform an appendectomy, return the contents of the hernia sac into the abdominal cavity, and do a mesh installation. Amyand hernia itself presents a diagnostic challenge because of its low incidence, vague clinical signs and symptoms, and lack of clear radiological diagnostic features. In addition, there are still no clear guidelines for its management.

Amyand Hernia — An Uncommon Coexistence of Two Common Disease Entities

Amyand hernia is a very rare disorder characterized by presence of appendix (normal, inflamed or perforated) in the hernia sac. Though it is usually detected intra-operatively, ultrasonography or computerized tomographic scan done preoperatively may provide a clue. The presentation is determined by the condition of the appendix, and can mimic an incarcerated hernia. Though there are no standardized treatment protocols, management is mostly dictated by the condition of the appendix. We present the case of a 62-year-old male patient who presented with right sided obstructed inguinal hernia, which intra-operatively revealed an Amyand Hernia.

Amyand's hernia, case report and review of current literature

ABSTRACT Introduction: Amyand's hernia (appendix trapped within an inguinal hernia) is a rare clinical condition that groups two common surgical diseases: acute appendicitis and inguinal hernia. Its preoperative diagnosis is difficult, so it should be considered in cases of inguinal hernia before an inflammatory process occurs in the appendix to avoid complications. Although there is no consensus on its treatment, current classifications serve as a guide for a timely surgical resolution. Case presentation: A 57-year-old male patient from the southern coast of Ecuador consulted the emergency department of a secondary level health care institution due to a 24-hour history of painful and irreducible mass in the right inguinal region associated with hyporexia. The patient was diagnosed with incarcerated inguinal hernia and underwent a right inguinal hernioplasty, during which the appendix and cecum were found inside the hernia sac. Hernioplasty and appendectomy were performed using the Lichtenstein technique. The patient was discharged in good conditions and did not have any complications at 8- and 15-day follow-up. Conclusions: Amyand's hernia is increasingly reported. It is difficult to diagnose preoperatively due to its nonspecific symptoms. When suspected, imaging studies help its visualization and guide an individualized and early treatment, together with the current classifications of this type of hernias.

RESUMEN Introducción. La hernia de Amyand es una condición clínica infrecuente que agrupa a dos patologías quirúrgicas habituales: apendicitis aguda y hernia inguinal; en esta entidad el apéndice vermiforme se encuentra en el interior del saco de una hernia inguinal. Su diagnóstico preoperatorio es difícil, por lo que debe tenerse en cuenta en casos de hernia inguinal antes de que se presente un proceso inflamatorio, el cual puede traer más complicaciones; además, aunque no existe un consenso para el manejo según las clasificaciones actuales, estas sirven de guía para una resolución quirúrgica oportuna. Presentación del caso. Hombre de 57 años procedente de la costa sur de Ecuador, quien consultó al servicio de emergencias de una institución de segundo nivel de atención por un cuadro clínico de 24 horas de evolución que inició con la aparición de una masa dolorosa e irreductible en la región inguinal derecha asociada a hiporexia. El paciente fue diagnosticado con hernia inguinal incarcerada y se le practicó una hernioplastia inguinal derecha en la que se encontró el apéndice y el ciego dentro del saco herniario; durante este procedimiento también se realizó apendicectomía y hernioplastia con técnica de Lichtenstein. El paciente fue dado de alta en buenas condiciones y en controles posteriores, a los 8 y 15 días de la cirugía, no presentó complicaciones. Conclusiones. La hernia de Amyand es una entidad cada vez más frecuente que tiene un difícil diagnóstico preoperatorio debido a su cuadro clínico inespecífico. Ante la sospecha de esta patología se deben realizar estudios de imagenología que ayuden a su visualización y orienten, junto con las clasificaciones actuales de este tipo de hernias, un manejo individualizado y temprano.

Amyand's hernia during laparoscopy hernioplasty. Case eport

Amyand's hernia refers to a rare occurrence in which the vermiform appendix, either inflamed or normal, happens to be found in an inguinal hernia sac. Due to its rarity and unspecific clinical evidence, it is most commonly presented as an intra-operative finding. A laparoscopic approach becomes both a way to confirm the diagnosis and a therapeutic tool. Case report: We hereby report a case of a 62-year-old patient presenting with an asymptomatic bilateral inguinal hernia, previously treated on his right side in 2011 with an open approach. The elective laparoscopic surgery, during the right groin exploration, revealed a vermiform appendix, with no signs of inflammation, within the hernia sac. . A prosthetic laparoscopic hernioplasty without appendicectomy was performed and both early outpatient follow-up and 30-day outcome demonstrated excellent recovery. Conclusions: Appendicectomy, when necessary, and primary hernia repair at the same time can be safely performed by laparoscopy which may be considered an advantageous management giving its role in diagnosing, in confirming an Amyand's hernia, in exploring the abdominal cavity and in being a therapeutic tool at the same time(AU)

La hernia de Amyand se refiere a una ocurrencia rara en la que el apéndice vermiforme, ya sea inflamado o normal, se encuentra dentro de un saco inguinal herniario. Debido a su rareza y evidencia clínica inespecífica, se presenta más comúnmente como un hallazgo intraoperatorio. Un abordaje laparoscópico se convierte tanto en una forma de confirmar el diagnóstico como en una herramienta terapéutica. Caso clínico: Presentamos un caso de un paciente de 62 años que presenta una hernia inguinal bilateral asintomática, previamente tratada en su lado derecho en 2011 con un abordaje convencional abierto. La cirugía laparoscópica electiva, durante la exploración de la ingle derecha, reveló un apéndice vermiforme, sin signos de inflamación, dentro del saco de la hernia. Se realizó una hernioplastia laparoscópica protésica sin apendicectomía y tanto el seguimiento ambulatorio temprano como el resultado a 30 días demostraron una excelente recuperación. Conclusión: La apendicectomía, cuando es necesario, y la reparación de la hernia primaria al mismo tiempo se pueden realizar de forma segura por laparoscopia que puede considerarse una gestión ventajosa dando su papel en el diagnóstico, en la confirmación de una hernia de Amyand, explorando la cavidad abdominal y siendo una herramienta terapéutica al mismo tiempo(AU)

Incarcerated Amyand hernia: a rare entity

Right sided inguinal hernia containing vermiform appendix in its sac is called as amyand’s hernia. It accounts for ∼1% of all inguinal hernias. It is an intra operative finding during an inguinal hernia repair. A 64 years old male patient came with complains of swelling in the right inguinal region, associated with pain and vomiting. On examination of the right inguinal region there was a tender irreducible swelling palpable. Based on the characteristic finding it was diagnosed clinically as right sided irreducible obstructed inguinal hernia. Ultrasound abdomen was done which was suggestive of right inguinal hernia with herniation of bowel and omentum with features of strangulated/ obstructed hernia. Patient was taken up for right inguinal hernia repair and appendix was noted in the hernial sac intra-operatively. Although occurrence of amyand’s hernia is rare. The attendant surgeon should be vigilant about the presence of it. Preoperative diagnosis of amyand’s hernia is not common because in majority of cases objective of imaging is to exclude conditions that predispose to inguinal hernia formation. The Losanoff and Basson’s criterion is used as a guide for deciding whether to perform appendectomy and type of repair, depend on the clinical scenario.

Amyand’s hernia: a case report

Amyand’s hernia is a rare pathology of an appendix with or without inflammation within the hernia sac is named after the French born English surgeon Dr. Claudius Amyand. We hereby present a case report of this rare entity known as a type 2 Amyand’s hernia. A 64 years old male, who had had a left-sided inguinal hernia for the previous 5 years, presented with a 2-day-history of fever, pain, vomiting, and irreducibility of the hernia. Upon exploration an irreducible inguinal hernia with appendix as its content was identified. Appendectomy was performed followed by a tension free mesh repair of the underlying hernia. Consequently, our recommendation is that the decision to perform an appendectomy and/or to use mesh to repair hernias should always be individualized.

Las hernias de Amyand y Garengeot como expresión del apéndice cecal en la región inguinofemoral / Amyand's Hernia and Garengeot's Hernia as Onset Manifestations of Cecal Appendix in the Inguinofemoral Region

RESUMEN La reparación de la hernia en la región inguinocrural es una de las operaciones más frecuentes en la práctica quirúrgica. Pueden encontrarse hallazgos inusuales, como el apéndice cecal parcial o completamente contenido en el saco herniario, lo que se denomina hernias de Amyand y Garengeot. Se presentan en aproximadamente el 1 por ciento de los pacientes con hernia inguinocrural, mientras que representan cerca del 0,1 por ciento de los casos de apendicitis. Clínicamente se presentan como una hernia inguinocrural incarcerada, y la ecografía o la tomografía axial computarizada pueden ayudar en el diagnóstico preoperatorio. El estado del apéndice cecal determina el acceso quirúrgico y el tipo de reparación herniaria. El objetivo de este artículo es desarrollar un material de apoyo a los profesionales implicados en la atención de estas raras entidades quirúrgicas(AU)

ABSTRACT Hernia repair in the inguinocrural region is one of the most frequent interventions in the surgical practice. Unusual findings can be found, such as the cecal appendix partially or completely contained within the hernial sac, called Amyand and Garengeot hernias. They occur in approximately 1 percent of patients with inguinocrural hernia, while they represent about 0.1 percent of the cases of appendicitis. Clinically, they present as an incarcerated inguinocrural hernia; ultrasound or computed tomography (CT) can assist in the preoperative diagnosis. The state of the cecal appendix determines surgical access and type of hernia repair. The objective of this article is to develop a support material for the professionals involved in the care of these rare surgical entities(AU)

Hernia de Amyand / Amyand’s hernia

La presencia del apéndice cecal en el saco de una hernia inguinal se denomina hernia de Amyand1,2. Su incidencia varía ‒según distintos autores‒ del 0,13% al 1,7%. Es una rara patología que se diagnostica intraoperatoriamente, ya que su diagnóstico preoperatorio es excepcional. No obstante, en citas bibliográficas se han descripto pocos casos de diagnóstico intraoperatorio, por lo que es importante tener la sospecha clínica en hernias incarceradas de cara al diagnóstico diferencial y a valorar la solicitud de estudios diagnóstico. Su tratamiento es la apendicectomía o reducción del apéndice cecal a la cavidad abdominal asociada a herniorrafia o hernioplastia³.

Amyand’s hernia is defined as an inguinal hernia containing the vermiform appendix1,2. This rare condition, with an incidence between 0.13% and 1.7%, is diagnosed during surgery, as the preoperative diagnosis is exceptional. Few cases of intraoperative diagnosis have been described in the literature. The diagnosis should be suspected in cases of incarcerated hernias so as to order the specific tests. The surgical management includes appendectomy or appendix reduction to the abdominal cavity associated to mesh repair or primary hernia repair without mesh³.

Clinical features of Amyand's hernia in neonates: cases report and literature review / 中华实用儿科临床杂志

Objective To investigate the characteristics of Amyand's hernia (AH) in neonates in order to decrease the complications and to improve the prognosis.Methods Data about neonates with AH in Department of Neonatal Surgery,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,were collected from January 2010 to February 2017,and the AH cases published from 1997 to 2017 in PubMed and Wanfang Data were also reviewed.Results Twenty-two cases were collected,including 8 cases treated in Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,and 14 cases from literature reports.In this group,4 cases underwent traditional operation and 4 cases underwent laparoscopy,respectively.All the patients underwent appendix resection and the ligation of the hernia sac.Among the 4 cases who underwent laparoscopic operation,contra-lateral hernia was found in 2 cases and pyocelia in 1 case.However,the appendix had a solid adhesion with the inguinal canal in those 4 cases and it was difficult to return the appendix to the cavity.Thus,the laparoscopy had to be terminated and the traditional procedure was carried out to separate the adhesion.In those 4 cases to whom the traditional operation was applied,1 case presented inflammation in abdomen and the contra-lateral hernia after operation.According to the pathological results of appendix,in this group,there were 3 cases,4 cases,and 1 case that presented Ⅱ,Ⅲ,Ⅳ type,respectively.In literature cases,there were 13 cases and 1 case that underwent traditional operation and laparoscopy,respectively.There were 4 cases,9 cases,and 1 case that presented Ⅱ,Ⅲ,Ⅳ type,respectively.The complications included located peritonitis (1 case),testicular torsion (1 case) and orchitis (1 case).All cases recovered smoothly.Conclusion Most of the AH cases in neonates present appendix suppuration,gangrene or perforation.The neonatal cases with AH also present obvious local infection and they are prone to develop into pyocelia in inguinal canal and abdominal cavity.In AH cases,laparoscopy has its own advantages,which not only help to make it clear if there is the contralateral hernia,but also helps to treat the complicated pyocelia in abdominal cavity,which help to avoid the residual infection efficiently.

Hernia de Amyand: presentación de un caso / Amyand hernia. Case report / Hérnia de Amyand. apresentação de um caso

RESUMEN La hernia inguinal es la protrusión de un órgano o fascia a través de la pared de la cavidad que lo contiene y es una de las situaciones más frecuentes que debe enfrentar el cirujano. Por lo general, el contenido de las hernias es epiplón o intestino delgado, pero ocasionalmente se puede observar el apéndice cecal, condición que se denomina "Hernia de Amyand". Esta es una situación infrecuente y de difícil diagnóstico, que generalmente se hace durante la intervención quirúrgica. Se presenta el caso de una hernia de Amyand en un hombre de 40 años que consultó por un cuadro de 10 horas de dolor en la región inguinal derecha, con masa palpable, dolorosa e irreductible; en la cirugía se encontró una hernia que contenía epiplón y el apéndice cecal con cambios inflamatorios. Se hicieron apendicectomía y hernioplastia inguinal por vía preperitoneal con aplicación de malla. No hubo complicaciones intraoperatorias y la evolución fue satisfactoria.

SUMMARY Inguinal hernia is the protrusion of an organ or fascia through the wall of the cavity that contains it. It is one of the most frequent situations that surgeons must face. Typically, the content of herniary sac is omentum or small bowel, but occasionally it includes the cecal appendix, a condition called "Amyand hernia". Diagnosis is usually established during surgical intervention. We present the case of an Amyand hernia in a 40 year-old male, who consulted by pain in the right inguinal region, lasting 10 hours. On physical examination a palpable, painful and irreducible mass was found. During surgery, the sac was observed to contain omentum and the cecal appendix, the latter with inflammatory changes. Pre-peritoneal inguinal hernia repair with application of a mesh was performed. No intra-operatory complications occurred and the outcome was satisfactory.

RESUMO A hérnia inguinal é a protrusão de um órgão ou fáscia através da parede da cavidade que os contém e é um dos procedimentos cirúrgicos mais frequentes aos que vai enfrentar o cirurgião. Comumente o conteúdo das hérnias é Epiplon ou intestino delgado e em poucas ocasiões se pode observar a apêndice cecal, condição que se denomina "Hérnia de Amyand". Esta é uma situação pouco frequente e de difícil diagnóstico, que geralmente se diagnostica durante a intervenção cirúrgica. Se apresentou o caso de uma hérnia de Amyand em um paciente masculino de 40 anos de idade que consultou por quadro de 10 horas de dor na região inguinal direita, com massa palpável, dolorosa e irredutível; foi levado a cirurgia e foi durante a qual se encontrou uma hérnia com conteúdo de Epiplon e apêndice cecal com câmbios inflamatórios, se realizou apendicectomia e hernioplastia inguinal por via pré-peritoneal com aplicação de malha. Não se apresentaram complicações intraoperatórias e a evolução foi satisfatória.

Hernia de Amyand. Reporte de caso / Amyand's hernia. Case report

La incidencia de la hernia de Amyand es muy baja. Siempre es diagnosticada en el transoperatorio, resulta casi imposible de realizar durante el pre-operatorio. Paciente femenina de 75 años de edad, con antecedentes de hernia inguinal derecha recidivante. Comenzó con dolor en epigastrio y en región inguinal derecha, además de náuseas y vómitos. Se identificó cicatriz quirúrgica y aumento de volumen en región inguinal derecha. Se decidió intervenir quirúrgicamente con el diagnóstico clínico de hernia inguinal derecha recidivante encarcelada. Durante el acto operatorio se identificó apendicitis aguda supurada como contenido del saco herniario inguinal. Se procedió a la realización de la apendicetomía y reparación de la hernia, en el mismo tiempo quirúrgico, y colocó la malla de polipropilenoe. Se aplicó antibióticos de amplio espectro. La paciente evolucionó de forma favorable. La biopsia confirmó el diagnóstico. El siguiente caso se presentó, pues a pesar de ser conocido, su incidencia es muy baja, por lo que existen dificultades para su diagnóstico (AU).

The incidence of Amyand's hernia is very low. It is always diagnosed in the trans-operatory period, being almost impossible during the pre-operatory period. This is the case of a female patient, aged 75 years, with antecedents of recidivist right inguinal hernia. It began with pain in epigastrium and in the right inguinal region in addition to nausea and vomits. Surgical scar and volume increase in the right inguinal region were identified. It was decided to make a surgery with the clinical diagnosis of incarcerated recidivist right inguinal hernia. During the surgery an acute suppurated appendicitis was identified as the content of the inguinal hernial sac. The appendectomy was carried out and hernia was repaired in the same surgical time; a polypropylene mesh was placed. Broad spectrum antibiotics were applied. The evolution of the patient was satisfactory. The biopsy confirmed the diagnosis. The case was presented because despite of being known, its incidence is very low, so there are difficulties for diagnosing it (AU).

Hérnia de Amyand à Esquerda: relato de caso e revisão de literatura / Amyand's Hernia: case report and literature review

Introdução: A presença de apêndice vermiforme no interior de um saco herniário na região inguinal foi descrita pela primeira vez em 1735, por Claudius Amyand. Desde então a "Hérnia de Amyand" tem sido relatada pela literatura mundial como evento raro, correspondente a cerca de 1% de todas as hernias. Seu aparecimento à esquerda é ainda mais raro, com apenas 5 casos descritos nos útlimos 25 anos. Métodos: Paciente masculino, 68 anos e 11 meses de idade, se apresenta na emergência com quadro de dor em região inguinal esquerda, sintomas de quadro suboclusivo e abaulamento em ambas regiões inguinais. No intra-operatório encontrado Hérnia de Amyand à Esquerda, e realizado orquiectomia e enterectomia segmentar em bloco por aderências encontradas pelo processo crônico. Reparo realizado com uso de Tela de Polipropileno. Alta no 7˚ P.O. sem complicações. Revisão da literatura através de pesquisa ao Medline. Discussão: Durante a revisão de literatura foram encontrados 5 casos descritos de Hérnia de Amyand à esquerda. Foram revisados também séries de casos e relatos com revisão de literatura. Em virtude do raro aparecimento desta hérnia, as condutas tomadas se baseiam na experiência do cirurgião e no achado intra-operatório. Existem na literatura artigos que podem servir como base de conduta através de uma tentativa de classificação das Hérnias de Amyand e padronização de terapêutica cirúrgica. Conclusão: Diante da heterogeneidade das condutas e a raridade do aparecimento deste tipo de hérnia é evidente a necessidade da realização de revisão sistemática para a busca de padronização principalmente da terapêutica cirúrgica.

Background: The presence of an vermiform appendix in a herniary sac on groin area was described for the first time in 1735, by Claudius Amyand. Since then, Amyand's Hernia has been described by the worldwide literature as a rare event, corresponding circa 1% of all hernias. Its appearance to the left is even rarer, with only 5 cases described in the past 25 years. Methods: Male patient, 68 years and 11 months old, comes to the emergency room presenting pain on the left groin area, suboclusive symptoms and lump on both groin areas. In the surgery was found left Amyand's Hernia, and procedure enbloc orchiectomy and segmentar enterectomy from adherences found by the chronic inflammatory process. Repair was made using the Polypropylene Mesh. End of treatment on the 7th P.O. without complications. Literature review through research to the Medline. Discussion: During the literature review there were found 5 cases described of left Amyand's Hernia. There were also reviewed series of cases and reports with the literature. Due to the rare appearance of this hernia, the conducts taken are based in the experience of the surgeon and in surgery founds. There papers in the literature that may serve as conduct base through a trial of classifying of the Amyand's Hernia and standard therapeutic surgery. Conclusion: Facing the heterogeneity of the conducts and rarity of the appearance of this sort of hernia it is evident the necessity of systematic review to find a standard, mainly for the surgery therapeutics.

Hernia de Amyand en el lactante / Amyand's hernia in a nursing child

La presencia de un saco herniario inguinal ocupado por un apéndice cecal inflamado es conocida en la literatura como hernia de Amyand. La descripción data del 1735 por Claudius Amyand, quien realiza la primera apendicetomía satisfactoria en un niño de 11 años. Su incidencia en la edad pediátrica es rara, y usualmente es diagnosticada en el curso de la evaluación de una hernia inguinal complicada. Se presenta un paciente de 7 meses de vida que recibió atención médica en nuestra institución, y se realizó, además, una revisión de la literatura en relación con esta entidad.

The presence of an inguinal hernial sac occupied by an inflamed cecal appendix is known in scientific literature as Amyand's hernia. The description dates back to 1735 when Claudius Amyand performed the first satisfactory appendicectomy in a 11 years-old boy. The incidence of this disease is rare at pediatric ages and is usually diagnosed in the course of evaluation of a complicated inguinal hernia. This is a 7 months-old patient who was attended to and treated in our institution and additionally, a literature review on this entity was made.

Reporte de un paciente con Hernia de Amyand / Report of a Patient with Amyand Hernia

La hernia de Amyand es un padecimiento muy raro, que se reconoce ante la presencia de apendicitis aguda dentro de un saco herniano. El diagnóstico preoperatorio es excepcional. El tratamiento recomendado es la apendicectomía y reparación de la hernia en el mismo tiempo operatorio. Se presentó el caso de un paciente de 56 años de edad con antecedentes de hernia inguinal derecha desde hace 10 años que acudió con dolor abdominal relacionado con la presencia de esta, que se encontraba en esos momentos irreductible, el dolor se irradiaba a todo hemiabdomen inferior, con defensa muscular hacia fosa iliaca derecha. Se realizó intervención quirúrgica detectándose en el transoperatorio la presencia de epiplón y apéndice cecal edematoso dentro de saco herniano. Se procedió a la realización de la apendicetomía y reparación de la hernia inguinal en el mismo tiempo quirúrgico, se decidió la colocación de malla de Marlex. La evolución fue satisfactoria.

Amyand's Hernia is a very rare pathology that is recognized by the presence of inflamed appendix inside an inguinal hernia. The pre-operative diagnosis is exceptional. The recommended treatment is the appendectomy with herniotomy in the same operative time. A 56 -year- old male patient with history of right inguinal hernia of approximately 10 years of evolution was presented. He was attended because of abdominal pain related to the presence of an inflamed inguinal mass, non-reducible, associated to muscular defense to the right inguinal region. Surgical intervention was performed detecting the presence of epiplon and edematous vermiform appendix within the hernia sac. An Appendectomy and reparation of the inguinal hernia were done in the same surgical time, Marlex mesh was decided to use. The patient´s evolution was satisfactory.

Hérnia de Amyand: relato de caso / Amyand's hernia: a case report

Objetivo: relatar um caso de hérnia de Amyand ,corrigida ,cirurgicamente,na Fundação Santa Casa de Misericórdia do Pará(FSCMPA),em Belém/PA. Relato de Caso: paciente do sexo masculino,57 anos,com hérnia inguinal recidivada a direita. Considerações finais: o presente caso relata o ocorrência de hérnia inguinal direita contendo o apêndice cecal no interior de seu saco herniário durante a correção cirúrgica.

Objective: To report a case of hernia Amyand corrected surgically in the Holy House of Mercy Foundation of Pará (FSCMPA), in Belém / PA. Case Report: A male patient, 57 years with recurrent inguinal hernia right. Conclusion: This case reports the occurrence of right inguinal hernia containing the appendix inside the hernia sac during its surgical correction.

Hernia De Garengeot / De Garengeot hernia

Las hernias contenedoras del apéndice cecal constituyen una rareza en la práctica médica habitual. Descritas por De Garengeot y Amyand hace más de 250 años, sigue siendo sorprendente el hallazgo intraoperatorio de un saco herniario que contenga este órgano. Objetivo: describir un caso de hernia De Garengeot. Presentación de caso: se presenta el caso de una paciente de 84 años que acudió a consulta de urgencias por presentar hernia crural irreductible y cuadro clínico sugestivo de oclusión intestinal mecánica. Intervención: se realizó laparotomía exploratoria. Durante el acto quirúrgico se encontró un tumor de la unión rectosigmoidea como causa de la oclusión intestinal y el apéndice vermiforme como contenido de la hernia crural. Se realizó apendicetomía, herniorrafia crural y transversostomía descompresiva en asa. Por las características de los canales inguinal y crural, la presencia del apéndice cecal en el interior de estos es infrecuente, por lo que el diagnóstico de este tipo de hernia es generalmente transoperatorio. Conclusiones: la hernia De Garengeot debe ser más comentada y difundida en los textos convencionales de cirugía por ser una afección bien descrita y tipificada en la historia de la cirugía moderna y que, igual que otros tipos de hernias, como la de Littré y Maydl, es una entidad poco frecuente; su diagnóstico tardío tiene un elevado riesgo para el paciente.

The cecal appendix wrapper hernias are rare in medical practice. Described by De Garengeot and Amyand over 250 years ago, the intraoperative finding of a hernia sac containing this body is still surprising. Objective: to describe a case of De Garengeot hernia. Description: a case of an 84 year- old female patient, who came to the emergency room for consultation due to irreducible femoral hernia and a suggestive clinical condition of mechanical intestinal obstruction, is presented. Intervention: exploratory laparotomy was performed. During surgery a tumor in the rectosigmoid junction is found as a cause of intestinal obstruction and the vermiform appendix was found to be the content of this femoral hernia. Appendectomy and decompressive loop transversostomy are performed. Due to the characteristics of inguinal and femoral canals, the presence of the appendix within these canals is uncommon; that is why the diagnosis of this type of hernia is usually intraoperative. Conclusions: De Garengeot hernia should be more widely discussed in conventional surgery texts since it is a condition to be well described and typified in the history of modern surgery which, like other types of hernias, as Littre and Maydl, is a rare entity. Its late diagnosis is high risk to the patient.

Amyand Hernia: Sonographic and CT Appearances

Herniation of the appendix into an inguinal canal is known as an Amyand hernia. Due to its nonspecific symptoms, clinical diagnosis is extremely difficult, and an accurate preoperative diagnosis of Amyand hernia with ultrasound (US) and CT is rarely reported. Herein, we reported a typical case of Amyand hernia in a 74-year-old male in which the correct diagnosis was made using inguinal US and contrast-enhanced abdominopelvic CT. US and CT findings of Amyand hernia showed a target-like tubular structure within the inguinal canal.

Atypical contents of inguinal hernial sac: A surgical dilemma.

Unusual contents in inguinal hernial sac are uncommon. Appendix, ovary or urinary bladder is more frequent than other abdominal organs. To deal with an unexpected organ during surgery is a surgical dilemma. We present two cases of appendix (Amyand’s Hernia) and third one with ovary in inguinal sac.

Amyand’s Hernia.

Acute appendicitis in an incarcerated inguinal hernia is termed an Amyand’s hernia. This is an extremely rare condition. It is often misdiagnosed as a strangulated inguinal hernia. The clinical presentation varies, depending on the extent of inflammation in the hernia sac and the presence or absence of peritoneal contamination. We report a case of Amyand’s hernia in a 2 year old boy who presented with shock. The basic principle in our management was to stick to the principles of resuscitation and stabilisation of the patient completely before surgery, which lead to a very successful outcome. Emphasis is given to the rarity of the disease and to the review of the literature.

Amyand's Hernia with Periappendicular Abscess

The presence of a vermiform appendix in an inguinal hernia is known as Amyand's hernia. It is rare condition that occurs in about 0.51% of the cases of inguinal hernia. Appendicitis within an Amyand's hernia is found in 0.10% of all forms of external hernia sacs. It is often misdiagnosed as a strangulated inguinal hernia. We experienced a case of Amyand's hernia with a periappendicular abscess within a right inguinal hernia sac in a 71-year-old male patient. Combined appendectomy and Bassini's herniorrhaphy were performed. The patient had an uncomplicated postoperative course and he was discharged 8 days after admission.