An Incidental Discovery of Amyand's Hernia: A Case Study and Literature Review on Its Intraoperative Management

Left-Sided Amyand Hernia

An Amyand's hernia is defined by the presence of the vermiform appendix in the inguinal hernia sac. Most cases of Amyand's hernia are incidentally diagnosed intraoperatively while surgically reducing a right inguinal hernia. Right-sided Amyand's hernias are more common than left-sided Amyand's hernias for two reasons: the appendix is naturally located on the right side and right inguinal hernias are more common. The prevalence of an Amyand's hernia has been reported as 1%, but the true prevalence is much lower than that. We report a particularly rare case of a 5-month-old boy with a left-sided Amyand's hernia surgically repaired without appendectomy.

Amyand's hernia a case report

INTRODUCTION AND IMPORTANCE

Amyand's hernia (AH) is a form of inguinal hernia which is consider as very rare and this type of hernia occurred up to 1% of all inguinal hernia cases. In this type of inguinal hernia, the content of hernia sac is appendix. Most patient with AH often remains asymptomatic and diagnosed intraoperatively. The diagnosis is challenging, since needs a high index of suspicion and imaging is key. Surgery is the mainstay management. We report a case of Amyand's hernia that was managed operatively in our medium complex public institution.

CASE PRESENTATION

A 28 year's old man with normal body mass index (BMI) who had a history of right-side reducible linguino-scrotal swelling for 8 years, was admitted for elective right inguinal hernia repair. Two weeks back before admission, he noticed that swelling was slightly painful. Ultrasound of the abdomen reported normal findings. There was no history of abdominal pain and vomiting. Laboratory parameters were within normal limit. So, with a diagnosis of right sided partially reducible, incomplete, and indirect inguinal hernia, patient was operated for open hernia repair surgery, intra operatively we found dense adhesions within the sac, adhesions were released which revealed herniation of appendix into the inguinal canal. Appendix was mildly congested without gross evidence of inflammation. Hence, in view of noninflamed appendix, preperitoneal mesh (polypropylene) hernioplasty from Lichtenstein tension-free mesh repair was performed with appendicectomy. Postoperative period was uneventful, patient discharged at second day.

CLINICAL DISCUSSION

Amyand's hernia is very uncommon and characterized by the presence of the appendix in the hernia sac and it is 0.4-1% of all inguinal hernia cases, literature review also showed that incidence of Amyand's hernia is very rare, whereas only 0.1% of cases complicate into acute appendicitis due to late presentation and missed diagnosis.

CONCLUSION

Amyand's hernia (AH) makes up only a small proportion of most inguinal hernia cases, and its diagnosis is usually based on incidental finding intra-operatively. This condition may remain asymptomatic and behave like a normal inguinal hernia. Management of this type of hernia should be individualized according to appendix's inflammation stage, presence of abdominal sepsis and co-morbidity. With this approach it enables surgeons to manage more variations of Amyand's hernia. Laparoscopy for dealing Amyand's hernia is frequently diagnostic as well as therapeutic.