Management of Amyand’s Hernia: a Case Report

Abstract

Amyand’s hernia is a rare condition that involves the presence of the appendix in the inguinal hernia sac, accounting for around 1% of all inguinal hernias. Since the presentation and workup may not indicate the presence of an appendix in the sac, diagnosis is usually made intraoperatively. As it is a rare presentation, the lack of knowledge of its different types and their management may lead to uncertainty about the ideal course of action. A 60-year-old male patient presented with a recent onset of right inguinoscrotal swelling. The diagnosis of right irreducible hernia was made, and an elective open inguinal hernioplasty was decided. Intraoperatively, a long tubular vermiform appendix was identified in the sac along with the caecum. The appendix and the caecum were reduced, and hernia repair with mesh was done with good healing on follow-up. The management of Amyand’s hernia is dependent on the classification put forward by Losanoff and Basson based on the different conditions of the appendix and presence or absence of sepsis. The definitive diagnostic test of Amyand’s hernia pre-operatively is still a heavily debated topic. CT scan and sonography are the investigations that can most closely identify the appendix in the sac. This case report presents a Type 1 Amyand’s hernia which presented as an unremarkable irreducible right inguinal hernia which was diagnosed intraoperatively and managed with reduction and hernioplasty.