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A rare presentation of low-grade appendiceal mucinous neoplasm within an amyand's hernia: a case report
Hani Atiqah Saim1, Ian Chik1, Fahrol Fahmy Jaafar1
1Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Abstract:
An Amyand's hernia is characterised as the presence of the appendix in an inguinal hernial sac. During laparoscopic cholecystectomy for gallbladder polyps, an incidental Amyand's hernia was discovered in a 75-year-old female patient. On examination, the hernia contained an appendiceal mucocele but no evidence of perforation. An open appendicectomy with tension-free mesh repair was performed for the hernia. The histopathological report of the appendix was a low-grade appendiceal mucinous neoplasm (LAMN), an entity that is just as rare as an Amyand's hernia. The patient had the right inguinal swelling for over 10 years but it was thought to be an inguinal intramuscular cyst as reported on a previous abdominal ultrasound. Mucocele of the appendix may have a benign or malignant appendiceal progress, leading to individualised diagnosis and treatment. We review an Amyand's hernia with LAMN and discuss the asymptomatic tendency yet malignant potential of appendiceal mucoceles along with treatment strategies.
Insights
An incidental Amyand's hernia containing an appendiceal mucocele was found during gallbladder surgery. The mucocele was diagnosed as a rare low-grade appendiceal mucinous neoplasm (LAMN), highlighting the importance of investigating such rare hernia cases.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Amyand's hernia, defined as the appendix within an inguinal hernia sac, is a rare condition.
- Appendiceal mucoceles, while uncommon, can range from benign to malignant, necessitating careful diagnosis and management.
- The co-occurrence of Amyand's hernia and appendiceal mucocele is exceptionally rare.
Observation:
- A 75-year-old female patient undergoing laparoscopic cholecystectomy incidentally presented with an Amyand's hernia.
- The hernia sac contained an appendiceal mucocele without signs of perforation.
- A long-standing right inguinal swelling, previously misdiagnosed as a cyst, was identified as the hernia.
Findings:
- Histopathological examination revealed the appendiceal mucocele to be a low-grade appendiceal mucinous neoplasm (LAMN).
- The patient underwent open appendicectomy and tension-free mesh repair for the hernia.
- The LAMN diagnosis underscores the potential for malignancy in appendiceal mucoceles, even within a hernia.
Implications:
- This case highlights the diagnostic challenge and potential for malignancy in appendiceal mucoceles associated with Amyand's hernia.
- Early recognition and appropriate surgical intervention are crucial for managing these rare conditions.
- Further research into the natural history and optimal treatment strategies for concurrent Amyand's hernia and appendiceal neoplasia is warranted.
