Surgical Management of a Strangulated Amyand s Hernia in an Emergency Situation: A Practical Approach

Case Report

Austin J Surg. 2023; 10(4): 1310.

Surgical Management of a Strangulated Amyand’s Hernia in an Emergency Situation: A Practical Approach

Ouhammou Yousra¹*; Dady Mohammed¹; Laamri Imad¹; Maouni Ilyass¹; Abou Elalaa Khalil²; El Alami Fahd Hassan¹

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

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

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

Abstract

Amyand’s hernia is a rare condition characterized by the presence of the appendix within an inguinal hernia. Although rarely seen, strangulated Amyand’s hernia is a surgical emergency requiring immediate management to avoid potentially serious complications.

This condition, named after the French surgeon Claudius Amyand [1], is estimated to affect around 1% of inguinal hernia cases, with a prevalence of appendicular inflammation of only 0.1% [2]. It is more common in children, due to the permeability of the vaginal process [3].

In such situations, a practical approach involving immediate surgical exploration is warranted. Prompt treatment is essential to avoid serious complications, such as appendicular perforation or peritonitis. Surgical expertise, careful clinical assessment and patient-centered decision-making are essential for the successful management of these emergency cases.

In conclusion, strangulated Amyand’s hernia is a rare condition that requires prompt surgical management. In emergency situations, early surgical exploration is recommended to avoid potential complications. This clinical observation illustrates the importance of practical decision-making in the management of such emergency cases, and highlights the need for a multidisciplinary approach involving surgical expertise and thorough clinical evaluation.

Keywords: Amyand’s hernia; Strangulation; Surgical emergency; Surgical exploration; Practical decision-making

Introduction

A strangulated Amyand’s hernia presents a unique and rare surgical emergency. The presence of the appendix within an inguinal hernia is estimated to occur in approximately 1% of cases, with inflammation found in only 0.1% [4]. The clinical presentation of a strangulated Amyand’s hernia often manifests with acute symptoms, necessitating immediate intervention. While imaging techniques such as CT scan and ultrasound are valuable diagnostic tools, in certain emergency situations, prompt access to these imaging modalities may not be feasible. Consequently, an immediate surgical exploration becomes essential for timely decision-making and management [5].

The rarity and distinctive clinical presentation of a strangulated Amyand’s hernia make it of significant scientific interest. Published cases contribute to expanding our understanding of this condition, particularly in circumstances where immediate imaging studies are not readily available. By presenting an illustrative observation of a strangulated Amyand’s hernia managed through urgent surgical exploration, this article aims to highlight the challenges encountered in emergency settings and emphasize the critical role of surgical expertise in making prompt decisions.

This article explores the scientific significance of managing a strangulated Amyand’s hernia, emphasizing the practical challenges faced when immediate imaging is not accessible according to emergency protocols. Through the discussion of this unique observation, the study contributes to the existing scientific literature, providing valuable insights into the management of surgical emergencies. The presented case underscores the importance of a multidisciplinary approach, involving clinical acumen and surgical expertise, in addressing the complexities associated with a strangulated Amyand’s hernia.

Clinical Observation

We report the case of a 72-year-old man with a history of well-controlled hypertension on calcium channel blockers. The patient was admitted to the surgical emergency department of our hospital with suspected strangulated hernia. Given the presence of characteristic clinical symptoms such as acute groin pain for 3 days and a hernial protrusion already diagnosed as an inguinal hernia, urgent surgery was indicated as soon as anesthesia conditions allowed. The pre-operative check-up did not reveal any biological abnormalities, such as a blood ionogram, renal function, blood glucose, and an electrocardiographic trace.

In accordance with the department's protocols, no prior imaging was carried out in this case of hernia emergency. The intense pain and irreducible hernia were sufficiently suggestive clinical signs to justify immediate surgical exploration.

At the time of surgery, an Amyand's hernia was discovered, accompanied by inflamed appendicitis (Figures 1,2). No other abdominal abnormalities were identified during the preoperative work-up. Appendectomy was performed successfully, and the patient recovered without postoperative complications.

Citation: Yousra O, Mohammed D, Imad L, Ilyass M, Khalil AE, et al. Surgical Management of a Strangulated Amyand’s Hernia in an Emergency Situation: A Practical Approach. Austin J Surg. 2023; 10(4): 1310.