Amyand's hernia: non incarcerated, inflamed appendix in inguinal sac case report
Faranak Olamaeian1, Mahdi Saberi Pirouz2, Fatemeh Sheibani2
1Firoozabadi Clinical Research Development Unit (F A CRD U), Iran University of Medical Sciences (IUMS), Tehran, Iran.
Abstract:
Inguinal hernia is described as protrusion of abdominal structures into inguinal canal, such as intestinal loop and abdominal fascia. Appendix rarely bulges into inguinal canal which is called Amyand's hernia. A 55-year-old diabetic male presented to an outpatient clinic with right inguinal bulging since 2 years ago which was non-tender, without erythema and became non reducible since 2 days ago. Also bulging worsened by physical activity. The patient went through operation and an inflamed appendix was found stuck in hernia sac. Non incarcerated inguinal hernia can be diagnosed with physical examination and there is no need of further imaging which makes it hard to diagnose the nature of protrusion. Amyand's hernia usually presents with pain due to appendicitis which mimics incarcerated hernia and makes it easier to suspect the etiology and request for further investigation. However in this case, pain was suppressed and this patient was candidate for elective inguinal herniotomy.
Insights
Amyand's hernia, a rare inguinal hernia involving the appendix, can be difficult to diagnose when appendicitis symptoms are absent. This case highlights a unique presentation of an inflamed appendix within an inguinal hernia sac.
Area of Science:
- Medicine
- Surgery
- Gastroenterology
Background:
- Inguinal hernias involve abdominal structures protruding into the inguinal canal.
- Amyand's hernia is a rare type where the appendix enters the inguinal canal.
Observation:
- A 55-year-old male presented with a 2-year history of non-tender, irreducible right inguinal bulging, worsening with activity.
- Physical examination alone is often insufficient for diagnosing the contents of a non-incarcerated inguinal hernia.
Findings:
- Surgical exploration revealed an inflamed appendix within the inguinal hernia sac.
- Unlike typical Amyand's hernia presentations, this case lacked significant pain, masking appendicitis symptoms.
Implications:
- This case underscores the diagnostic challenges of atypical Amyand's hernia presentations.
- Early surgical intervention is crucial for managing incarcerated or inflamed hernias, even with subtle symptoms.
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