Amyand's Hernia: An Uncommon Encounter of an Appendiceal Presence in an Inguinal Hernia.

Amyand's hernia is a rare variant of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. It represents a unique diagnostic and management challenge for surgeons due to its low incidence and varied clinical presentations. Here, we present a case of a 45-year-old man with a one-year history of right inguinoscrotal swelling, diagnosed as a right indirect inguinal hernia. Preoperative imaging revealed the presence of omentum within the hernia sac. Intraoperatively, both the omentum and the vermiform appendix were found within the sac without evidence of inflammation. The patient underwent successful Lichtenstein meshplasty without appendicectomy. This case highlights the importance of considering Amyand's hernia in the differential diagnosis of inguinal hernias and the significance of intraoperative findings in guiding surgical management. Further studies and case reports are needed to enhance our understanding of this rare clinical entity and optimize patient outcomes.

Amyand's hernia: a case of right inguinoscrotal hernia with appendiceal content.

Introduction: Amyand's hernia, a rare condition where the appendix becomes lodged in the inguinal canal, poses diagnostic challenges due to its varied clinical presentations and lack of distinctive radiological features. This case underscores the importance of early detection and comprehensive diagnostic evaluation. Case Presentation: A 30-year-old male presented with a 2-year history of right inguinoscrotal swelling, culminating in agonizing symptoms and irreducible masses over the inguinoscrotal area. Despite the absence of significant medical history, diagnostic imaging confirmed a complete right inguinoscrotal hernia and bilateral hydrocele with internal echoes. Clinical Discussion: The case illustrates the difficulties in preoperative diagnosis of Amyand's hernia, emphasizing the reliance on imaging modalities and clinical assessment. Successful surgical intervention involving appendectomy and hernioplasty highlights the necessity for prompt diagnosis and management. Conclusion: This case exemplifies the challenges and complexities associated with Amyand's hernia, emphasizing the importance of early recognition and comprehensive surgical planning. Moving forward, increased clinical vigilance and awareness are essential to ensure optimal patient outcomes in cases of inguinoscrotal pathology.

Amyand's Hernia diagnosed preoperatively via a CT scan: A case report.

Amyand's hernia is a rare type of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. It was named after Claudius Amyand who performed the world's first successful appendectomy on an 11-year-old boy with a right inguinal hernia in 1735 and discovered a herniated appendix during surgery. This condition warrants urgent surgical treatment, with the type of surgical intervention depending on the appendix's condition. However, the nonspecific clinical presentation often complicates the preoperative diagnosis, emphasizing the critical role of imaging in surgical planning. Herein, we present the case of a 74-year-old male who presented with fever, inguinal swelling, and discomfort. Clinical suspicion of inguinal and scrotal inflammation prompted us to perform a prompt CT scan. This radiological evaluation led to a preoperative diagnosis of a Type 3 Amyand's hernia. This case highlights the significance of CT scans in the accurate and timely diagnosis of Amyand's hernia. Distinguishing between various types of Amyand's hernia is pivotal as it profoundly influences surgical decision-making and postoperative outcomes. By sharing this case, we contribute to current knowledge about Amyand's hernia, increase clinical awareness of the condition, and emphasize the crucial role of imaging in its management.

Amyand's hernia repair in an asymptomatic patient-a case report and a review of the literature.

Amyand's hernia is a rare condition, in which the appendix is found in the inguinal hernia sac. Many patients remain asymptomatic and this pathological condition is most commonly diagnosed intraoperatively. We report a case of a 66-year-old male who was admitted to the hospital for an inguinal hernia repair and the presence of the appendix in the inguinal hernia sac was discovered intraoperatively. We performed a reduction of the appendix in the abdominal cavity and a hernia repair with a mesh and a plug. There are few studies in literature about the appropriate method of treatment and, because of that, the therapeutic approach remains controversial. Therefore, we also conducted a review of the literature in order to obtain some conclusions regarding the management of Amyand's hernia.

Amyand's hernia in a 3-month-old infant: A case report.

Amyand's hernia is a rare condition characterized by an inguinal hernia containing the appendix, which can lead to complications. It is more common in children and it can be challenging to diagnose due to its location, often being mistaken for other conditions like strangulated hernias, orchitis-epididymitis, or testicular torsion. Imaging, including computed tomography and sonography, plays an important role in diagnosis, which is usually made intraoperatively. A case concerning a 3-month-old boy with a large acute scrotum that had been evolving for 4 days was presented. Clinical examination revealed a hard inguinal mass and a large scrotum with signs of inflammation. An inguinoscrotal ultrasound found a herniated appendix, suggesting the diagnosis of Amyand's hernia, which was confirmed after surgery.

Amyand's Hernia: A Rare Case Study of Perforated Appendicitis in an Inguinal Hernia.

Amyand's hernia is defined as the presence of an appendix contained within an inguinal hernia. An inguinal hernia is the protrusion of a small or large bowel through a peritoneal defect of the groin. In rare cases, the appendix can become incarcerated or strangulated within the hernia, cutting off the blood supply to the organ. If incarcerated, the appendix is at risk for strangulation, which can lead to rupture and cause worsening of symptoms and/or collapse. We report a case of a 76-year-old male with a history of inguinal hernia repair 30 years prior, who presented with 30 days of intermittent right lower quadrant pain and unintentional weight loss. He required emergent treatment and management. This case underscores the challenge of diagnosing concurrent inguinal hernia and appendicitis and places an emphasis on timely intervention. Treatment options vary based on the appendix's apparent condition within the hernia sac. Despite the complications, including additional drainage site and enterocutaneous fistula, the patient was discharged in stable condition. This case contributes insights into managing complex inguinal pathologies, particularly in the geriatric population.

Amyand's hernia with concurrent appendicitis: A case of interval laparoscopic herniorrhaphy and literature review.

INTRODUCTION AND IMPORTANCE: Amyand's hernia with concurrent appendicitis is rare, with a reported incidence of 0.13 % of all inguinal hernias. This condition is challenging to diagnose and manage and no optimal treatment has been established. CASE PRESENTATION: A 71-year-old man presented with an acutely painful, tender, and irreducible right inguinal hernia. He had a history of a right inguinal hernia for several months and had undergone open left inguinal hernia repair. The patient had no other medical comorbidities. Blood test results were nonspecific, with a C-reactive protein of 90 mg/L. Ultrasound scan suggested a strangulated right inguinal hernia. Laparoscopy revealed an Amyand's hernia with concurrent appendicitis and a pus-filled right inguinal hernia sac. The patient underwent laparoscopic appendicectomy, followed by staged laparoscopic transabdominal preperitoneal right inguinal hernia repair with mesh after eight weeks to reduce mesh infection. Histopathological examination confirmed acute uncomplicated appendicitis without perforation or malignancy. The patient had an unremarkable post-operative recovery. DISCUSSION: This case highlights the diagnostic challenges associated with Amyand's hernia and concurrent appendicitis. Laparoscopy provides both diagnostic and therapeutic opportunities. In this case, laparoscopic mesh herniorrhaphy was delayed and staged until local hernia sac inflammation resolved following appendicectomy. CONCLUSION: Surgeons should have an index of suspicion for Amyand's hernia given the heterogeneity of presentations. A case-by-case approach is required to prevent post-operative complications and determine the safe timing of definitive hernia repair when the inguinal hernial sac is inflamed. Further research is required to provide surgeons with evidence-based approaches for this unique condition.

Two cases of intraoperative diagnosed Amyand hernia: Case report and literature review.

INTRODUCTION: Amyand hernia is the presence of an incarcerated vermiform appendix (either inflamed or not) within the hernia sac. This type of hernia is very rare with an incidence reported to be 0.5 to 1 % and even rarer in adults. CASES PRESENTATION: We present here two cases of male patients found the have an Amyand Hernia diagnosed incidentally intraoperatively, and managed with appendectomy and mesh herniorrhaphy. CLINICAL DISCUSSION: For the management of this type of hernia, in general, the surgeon should perform an appendectomy with the repair to prevent future herniation or appendicitis, but some opinions differ, and state that when there are no signs of inflammation, it is not required to perform a preventative appendectomy. CONCLUSION: The decision on how to manage depends on multiple factors including inflammation of the appendix, the possibility of abdominal sepsis, and the patient comorbidities. The status of the appendix determines whether to undergo hernia repair with or without mesh.

Emergency totally laparoscopic surgery for appendicitis in right Amyand's hernia associated to symptomatic left inguinal hernia: A case report.

INTRODUCTION AND IMPORTANCE: Amyand's hernia is a rare type of inguinal hernia which contains vermiform appendix in the inguinal sac, seldom complicated by acute appendicitis. It is usually repaired by open inguinal approach, but laparoscopic technique has been increasingly described in literature; nevertheless, standard of care is far from being defined. Here we report the case of Amyand's hernia complicated by acute appendicitis and simultaneous symptomatic left inguinal hernia, both repaired by laparoscopic technique. CASE PRESENTATION: A 85-years-old man presented with acute appendicitis in Amyand's hernia and simultaneous incarcerated left inguinal hernia. CLINICAL DISCUSSION: After complete preoperative work-up, the patient underwent laparoscopic appendectomy and laparoscopic bilateral hernia repair with mesh. CONCLUSION: Laparoscopic approach may be safe and feasible for Amyand's hernia treatment in emergency setting when performed by expert hands, with minimized risk of surgical site infection (SSI), quick recovery and reduced hospital stay. Laparoscopic hernia repair with mesh can be a reasonable approach in selected cases of bilateral or recurrent hernia, and concomitant intrabdominal inflammation, especially when contamination is scarse and limited to a restricted area.

Amyand's Hernia: Incarcerated Appendicitis in a Recurrent Inguinal Hernia in an Adult.

Inguinal hernias are among the most common cases presented to a surgeon. In spite of extensive research and clinical experience over centuries, inguinal hernias still pose anatomical challenges for operating surgeons, especially with a propensity for recurrence. One such complicated entity is the Amyand's hernia - defined as an inguinal hernia contained within the hernial sac - the vermiform appendix - as the herniated content. It is a rare clinical presentation and carries with it certain complexities with regard to operative decisions and clinical management. We present a case of a 71-year-old male presenting with a recurrent inguinal hernia, with an incarcerated, inflamed appendix as the content; managed surgically with appendicectomy and herniorraphy, without the use of a prosthetic mesh.

Perforated Amyand hernia with an adenocarcinoma tumour presenting as a groin abscess.

An Amyand hernia is an incarcerated inguinal hernia containing the appendix with or without appendicitis. This is a rare form of inguinal hernia, making up approximately 0.4%-1% of all cases. As with any hernia, this may become strangulated at any time, leading to the loss of blood supply and further development of gangrene and complications. Clinically, this can present in a manner indistinguishable from other types of inguinal hernias. In addition, the appendix can be affected by its own set of pathological processes, such as infection, inflammation, and malignancy. Not uncommonly both hernial and appendiceal complications coexist. The clinical diagnosis of an Amyand hernia remains challenging due to its low incidence and indistinct clinical presentation. At present, surgery is usually diagnostic and therapeutic. However, there is a growing number of recent reports showing the invaluable role of imaging on the diagnosis of Amyand hernias and associated complications. The correct and timely recognition of their imaging features including complications can optimize and expedite patient care by guiding diagnosis, treatment, and prognosis. Here, we report for the first time the radiological and pathological findings of a patient with a unique complicated Amyand hernia, which posed a diagnostic challenge for the clinical and radiological teams.

Conventional herniorrhaphy followed by laparoscopic appendectomy for a variant of Amyand's hernia: a case report.

BACKGROUND: Amyand's hernia (AH) is an appendix (with or without acute inflammation) trapped within an inguinal hernia. Most AH with acute appendicitis had a preexisting appendix within the hernia sac. We herein report a variant of AH that has never been described before. An inflamed appendix that was managed conservatively was found to have migrated and trapped in the sac of a previously unrecognized right inguinal hernia 6 weeks after the index admission, resulting in a secondary Amyand's hernia. CASE PRESENTATION: A 25-year-old healthy Taiwanese woman had persistent right lower abdominal pain for 1 week and was diagnosed with perforated appendicitis with a localized abscess by abdominal computed tomography (CT). No inguinal hernia was noted at that time. Although the inflamed appendix along with the abscess was deeply surrounded by bowel loops so that percutaneous drainage was not feasible, it was treated successfully with antibiotics. However, she was rehospitalized 6 weeks later for having a painful right inguinal bulging mass for a week. Abdominal CT revealed an inflamed appendix with abscess formation in an indirect inguinal hernia raising the question of a Amyand's hernia with a perforated appendicitis. Via a typical inguinal herniorrhaphy incision, surgical exploration confirmed the diagnosis, and it was managed by opening the hernial sac to drain the abscess and reducing the appendix into the peritoneal cavity, followed by conventional tissue-based herniorrhaphy and a laparoscopic appendectomy. She was then discharged uneventfully and remained well for 11 months. CONCLUSIONS: Unlike the traditional definition of Amyand's hernia, where the appendix is initially in the hernia sac, the current case demonstrated that Amyand's hernia could be a type of delayed presentation following initial medical treatment of acute appendicitis. However, it can still be managed successfully by a conventional tissue-based herniorrhaphy followed by laparoscopic appendectomy.

A rare case of De Garengeot hernia: CT findings.

We report a case of "De Garengeot's hernia" (DGH), a rare condition that occurs when the inflamed appendix is localized inside a femoral hernia. The appendix may be involved in inflammatory or necrotic processes and the treatment is emergency surgery. It is usually discovered by chance during surgery. It occurs in 0.5%-5% of all femoral hernias. In 0.08%-0.13% of cases, the appendix can present inflammatory or necrotic processes due to the narrowness of the neck of the femoral canal; in these cases, an emergency surgery is required through a no standard surgical procedure. In the other cases, it is usually found accidentally during surgical repair of the hernia or more rarely diagnosed preoperatively by CT. Therefore, the purpose of our study is to report a case of DGH describing CT main findings in order to improve the preoperative diagnosis.

An Amyand Hernia With Concurrent Appendicitis Secondary to a Neuroendocrine Neoplasm: A Case Report.

Amyand's hernia (AH) describes the rare instance of a vermiform appendix within an inguinal hernia. Primary appendiceal neoplasms are also rare with the majority of cases being found incidentally during routine histopathology. This case reports the management of a 15-year-old male, who presented to the emergency department with acute appendicitis located within an indirect right inguinal hernia, which was ultimately secondary to a neuroendocrine tumor (NET) with serosal involvement. Intraoperative findings included macroscopic appendicitis with no evidence of perforation. Histopathology returned as a neuroendocrine tumor (pT4) with involved proximal margin and curative treatment was undertaken with a caecectomy which returned no residual malignancy. Key considerations include management options of peritoneal spread within the inguinal canal and recommended management NET in the context of an AH. It is important to understand the varied presentations of common surgical diagnosis such as appendicitis and underlying malignancy should always be considered a differential.

De Garengeot Hernia, an acute appendicitis in the right femoral hernia canal, and successful management with transabdominal closure and appendectomy: a case Report.

Incarceration of the appendix within a femoral hernia is a rare condition of abdominal wall hernia about 0.1 to 0.5% in reported femoral hernia [1]. We report a case of a 56-year-old female whose appendix was trapped in the right femoral canal. There are few reports in the literature on entrapment of the appendix within a femoral hernia. The management of this condition includes antibiotics, drainage appendectomy, hernioplasty and mesh repair.

Amyand's hernia presented with strangulated and perforated appendicitis: A case report.

INTRODUCTION: Amyand's hernia (AH) is a rare condition in which the vermiform appendix is incarcerated within the inguinal hernia (IH) sac. Although infrequent, it may become inflamed or perforated and can typically be diagnosed either intraoperatively or through radiographic findings. PRESENTATION OF CASE: A 77-year-old male presented to the emergency room with constipation, fever, and an irreducible right inguinal bulge accompanied by slight localized discomfort that had persisted for ten days. Clinical examination was unremarkable, while ultrasound revealed a non-ischemic small bowel loop and a right testicular hydrocele, leading to a primary diagnosis of incarcerated IH. The patient was subsequently admitted for surgery, during which AH was confirmed. The appendix was inflamed, enlarged, and perforated, with localized abscess and internal inguinal ring stenosis. Subsequently, the surgical treatment involved appendectomy and hernia repair. DISCUSSION: According to the appendix condition, four subtypes of AH can be encountered, with type III -perforated appendicitis- being the focus of this report. In this case report, inguinal ring stenosis was the underlying cause of complications besides the unusual presentation features that were also attributed to adhesions that prevented peritoneal involvement. CONCLUSION: Surgeons should consider AH in the differential diagnosis of inguinal swelling and be familiar with the surgical management approach in the incidental event of AH during surgery.

Amyand's hernia containing appendiceal neuroma presenting as incarcerated inguinal hernia: A rare case report from Ethiopia.

INTRODUCTION AND IMPORTANCE: Amyand's hernia is a rare type of inguinal hernia which involves either a normal or diseased appendix within the hernia sac. We report an extremely rare case of appendiceal neuroma, presenting as an incarcerated Amyand's hernia. CASE PRESENTATION: A 55-year-old male patient presented in the emergency department due to a persistent right inguinal painful swelling. Clinical examination revealed a 5 cm × 3 cm firm and irreducible right groin mass. A diagnosis of an incarcerated right inguinal hernia was made, and the patient was prepared for surgery. Intraoperatively, a 5 cm × 3 cm firm mass originating from the distal part of the appendix was found in the hernia sac. An appendectomy and a modified Bassini hernia repair were done. The result of the histological examination revealed appendiceal neuroma, and no further surgical intervention was needed. DISCUSSION: Amyand's hernia encompasses various pathological features, including a normal, inflamed, or perforated appendix, and rarely appendiceal tumors. In the literature, we found about eight cases of malignant appendiceal tumors reported. Most of the cases indicate that the treatment of Amyand's hernia containing appendiceal tumors was an appendectomy alone, while one report with adenocarcinoma required a right hemicolectomy after biopsy result. Notably, there are no documented cases of appendiceal neuromas presenting as inguinal hernias in our search of English literature using Google Scholar and PubMed search engines. CONCLUSION: Amyand's hernia-containing appendiceal neuroma is an extremely rare entity. It is important to do histopathologic study to differentiate appendiceal neuroma from malignant tumors. In case of Amyand's hernia with appendiceal neuroma, simple appendectomy with hernia repair is adequate treatment.

Amyand's hernia with a perforated appendix and an enterocutaneous fistula: A case report.

INTRODUCTION: Amyand's hernia is a rare finding accounting for less than 1 % of inguinal hernias. The appendix with its pathology within the hernia sac may become isolated from the gastrointestinal tract, which can cause further confusion in clinical diagnosis. Awareness of the possibility of such appendiceal isolation could aid in clinical diagnosis. We report a rare case of Amyand's hernia complicated with a perforated appendix and an enterocutaneous fistula. PRESENTATION OF CASE: A 64-year-old gentleman with diabetes mellitus type II and hypertension presented with a right inguinal swelling associated with a malodorous discharge without features of intestinal obstruction. Ultrasonography revealed a right inguinal hernia with features of partial strangulation. He underwent a right inguinal exploration with subsequent debridement, appendicectomy and a herniorraphy. The patient had complete recovery and histopathology revealed acute appendicitis. DISCUSSION: Amyand's hernia is rare and difficult to diagnose pre-operatively. Appendicitis in Amyand's hernia is rarer still and may be caused by intraluminal or extraluminal obstruction. Clinical presentation is variable and ultrasonography and computed tomography (CT) scan aid in diagnosis. Appendicectomy is regarded as unnecessary when the appendix is normal. Synthetic mesh should be avoided when the appendix is inflamed or perforated. CONCLUSION: Amyand's hernia is rare and difficult to diagnose. Ultrasonography and CT scan are valuable tools for pre-operative diagnosis. Isolation of the appendix with its pathology within the hernia sac can add to the confusion in clinical diagnosis. Management of Amyand's hernia should be tailored according to the pathology encountered and treatment should not be delayed.

Amyand's hernia in a patient with acute complicated diverticulitis. A case report and review of the literature.

INTRODUCTION: Amyand's hernia with an inflamed or perforated appendix is rare with incidence of 0.1 % and 0.01 % of cases respectively. It has been described in conjunction with cecal perforation, cholecystitis and ureterolithiasis. Yet, its association with acute sigmoid diverticulitis has never been reported before. PRESENTATION OF CASE: A 57-year-old male presented to the emergency department with acute abdomen and an indurated right inguinal mass. A preoperative computed tomography (CT) scan reported a giant inflamed sigmoid diverticulum and an Amyand's hernia with a complicated appendicitis. The patient was taken to the operating room and a midline laparotomy incision was made. A giant sigmoid diverticulum with ischemic patches was encountered. The cecal appendix was found inside the right inguinal canal, with a perforation in its distal third. A Hartmann's procedure, appendicectomy and non-mesh inguinal hernia repair was accomplished. DISCUSSION: Case reports of Amyand's hernia in patients with simultaneous abdominal conditions are scarce. Symptoms in these patients could be various and may lead to preoperative imaging and diagnosis. In this case acute abdomen in physical examination demanded imaging analysis and a preoperative diagnosis of acute diverticulitis and Amyand's hernia with a perforated appendicitis was made. CONCLUSIONS: Amyand's hernia with acute perforated appendicitis is a rare entity. CT scan is useful for diagnosis of Amyand's hernia and associated conditions. Preoperative diagnosis of Amyand's hernia and concomitant abdominal disease aids in the therapeutic approach and management. To our knowledge this is the first case report of an Amyand's hernia in a patient with acute diverticulitis.

Amyand hernia as a rare cause of abdominal pain: A case report and literature review.

Key Clinical Message: Amyand's hernia is an uncommon kind of inguinal hernia in which the appendix becomes entrapped within the hernia sac. In patients with an inflamed or perforated appendix, mesh repair is not recommended for hernia repair. Abstract: Amyand's hernia is an uncommon kind of inguinal hernia in which the appendix becomes entrapped within the hernia sac. We report a 48-year-old man with a right groin protrusion and abdominal pain. In the abdominopelvic ultrasound, an appendix with a diameter of 9 mm was reported in the right inguinal canal. The patient was diagnosed with Amyand hernia.