Strangulated Hernia with Appendicitis: A Rare Case of Amyand s Hernia in a 72-Year-Old Man

Case Report

Austin Surg Case Rep. 2023; 8(1): 1059.

Strangulated Hernia with Appendicitis: A Rare Case of Amyand’s Hernia in a 72-Year-Old Man

Ouhammou Yousra¹*; Abou elalaa Khalil²; Dady Mohammed¹; Laamri Imad¹; El Alami FH¹

¹Department of the Emergency Surgery (UCV) - Ibn Sina University Hospital, Rabat, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco

²Department of Anesthesiology and Intensive Care, Head of the Operating Room Theatre Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco

*Corresponding author: Ouhammou Yousra Department of the Emergency Surgery (UCV) - Ibn Sina University Hospital, Rabat, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco. Email: ouhammouyousra2017@gmail.com

Received: August 02, 2023 Accepted: September 15, 2023 Published: September 22, 2023

Abstract

Introduction: Amyand’s hernia is an extremely rare and atypical hernia that is difficult to diagnose clinically characterised by engagement of the appendix in the inguinal sac. The aim of this report is to describe a case of Amyand’s hernia in a 72-year-old man with a history of hypertension on well-controlled calcium channel blockers, and to highlight the importance of surgical exploration in the diagnosis and management of this condition.

Case Report: We present a rare case of a 72-year-old man with a history of well-controlled calcium channel blocker hypertension presenting with intermittent right inguinal pain. The patient was admitted to the hospital’s surgical emergency department and was deemed in need of surgical exploration due to suspected strangulated hernia or irreducible hernial engorgement. Preoperative examination revealed no signs of appendicitis. During surgery, an Amyand’s hernia was discovered with an inflamed appendix. Intraoperative work-up was otherwise normal.

Discussion: Amyand’s hernia is an extremely rare condition, accounting for less than 1% of all adult inguinal hernias. Acute appendicitis in the context of Amyand’s hernia is even rarer, accounting for only 0.1% of all cases of acute appendicitis. This hernia may remain asymptomatic until inflammation of the appendix leads to incarceration, strangulation, necrosis, perforation or rupture. Early symptoms include inguinal tenderness and swelling. CT scanning is essential for accurate and early diagnosis of Amyand’s hernia, which can help avoid the complications of delayed surgery.

Conclusion: This case highlights the importance of early CT scanning for accurate diagnosis of Amyand’s hernia with appendicitis. Management of this rare condition requires appendectomy combined with repair of the hernia, depending on the degree of inflammation of the appendix and the anatomical features of the patient.

Keywords: Amyand’s hernia; Inguinal hernia; Appendicitis ; Hernial sac; CT scan; Appendectomy

Introduction

The contents of the inguinal hernial sac may contain various structures such as intraperitoneal fat, the small or large intestine, the bladder, the ovaries and even the appendix [1]. Among hernias, Amyand's hernia is distinguished by the presence of the appendix, whether inflamed or normal, in the inguinal hernial sac. The symptoms associated with this hernia may mimic those of an incarcerated hernia [2]. The incidence of an inflamed or perforated appendix found in Amyand's hernia is estimated to be 0.1% of all cases of appendicitis [3]. Amyand's hernia usually occurs on the right side and is characterised by tenderness and swelling in the inguinal or inguinoscrotal region [4].

Diagnosis of Amyand's hernia is clinically difficult due to its rarity and similar presentations with inguinal hernias. The diagnosis is often made incidentally, on imaging or during exploratory surgery [5-7]. Imaging tests such as Ultrasound (US) and Computed Tomography (CT) play a crucial role in distinguishing the different pathologies [5,7,8]. Computed Tomography (CT) allows direct visualisation of the appendix within the inguinal canal, facilitating accurate diagnosis [5]. According to Fernando et al, Amyand's hernia can be classified into three types according to the degree of inflammation of the appendix: (A) intact appendix without signs of inflammation, (B) appendix with signs of inflammation, and (C) perforated appendix [9]. Type A accounts for almost 90% of all cases [9]. Types B and C require appendectomy.