Hernia

, Volume 11, Issue 1, pp 31–35

Amyand’s hernia: a report of 18 consecutive patients over a 15-year period

  • H. Sharma
  • A. Gupta
  • N. S. Shekhawat
  • B. Memon
  • M. A. Memon
Original Article

Abstract

Aim

The presence of a vermiform appendix in an inguinal hernia sac is termed Amyand’s hernia. It may present as a tender inguinal or inguino-scrotal swelling and is often misdiagnosed as an incarcerated or strangulated hernia. The purpose of this study was to review the management of Amyand’s hernia at a single institution since 1991.

Material and methods

A retrospective analysis was undertaken of 18 consecutive patients with an Amyand’s hernia operated upon at our institution from 1991 to 2005. Patients’ demographics, treatment and postoperative outcome were analysed.

Results

There were 17 men and one woman. Their median age was 42 years. None of the patients was diagnosed preoperatively. The commonest presenting symptom was painful inguinal or inguino-scrotal swelling (83%). All patients, therefore, underwent emergency surgery with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 11 normal appendices, four inflamed appendices and three perforated appendices in the inguinal hernial sac. Patients with a normal appendix (n = 11) had a mesh hernia repair without an appendicectomy. The rest of the patients (n = 7) with an abnormal appendix underwent emergency open appendicectomy followed by Bassini’s sutured hernia repair. One patient died in the postoperative period of pneumonia. Only one recurrent hernia has been detected, with a median follow-up time of 6.4 years.

Conclusion

The inflammatory status of the appendix determines the type of hernia repair and the surgical approach. Incidental appendicectomy in the case of a normal appendix is not favoured.

Keywords

Hernia Appendicitis Appendicectomy 

References

  1. 1.
    Logan MT, Nottingham JM (2001) Amyand’s hernia: a case report of an incarcerated and perforated appendix within an inguinal hernia and review of the literature. Am Surg 67:628–629PubMedGoogle Scholar
  2. 2.
    House MG, Goldin SB, Chen H (2001) Perforated Amyand’s hernia. South Med J 94:496–498PubMedGoogle Scholar
  3. 3.
    Gupta S, Sharma R, Kaushik R (2005) Left-sided Amyand’s hernia. Singapore Med J 46: 424–425PubMedGoogle Scholar
  4. 4.
    Ash L, Hatem S, Ramirez GA, Veniero J (2005) Amyand’s hernia: a case report of prospective CT diagnosis in the emergency department. Emerg Radiol 11:231–232PubMedCrossRefGoogle Scholar
  5. 5.
    Apostolidis S, Papadopoulos V, Michalopoulos A, Paramythiotis D, Harlaftis N (2005) Amyand’s hernia: a case report and review of the literature. Internet J Surg 6:1Google Scholar
  6. 6.
    Solecki R, Matyja A, Milanowski W (2003) Amyand’s hernia: a report of two cases. Hernia 7:50–51PubMedGoogle Scholar
  7. 7.
    Kidmas AT, Iya D, Yilkudi MG, Nnadozie U (2004) Acute appendicitis in inguinal hernia: report of two cases. East Afr Med J 81: 490–491PubMedGoogle Scholar
  8. 8.
    Fernando J, Leelaratna S (2002) Amyand’s hernia. Ceylon Med J 47:71PubMedGoogle Scholar
  9. 9.
    Ryan WJ (1937) Hernia of the vermiform appendix. Ann Surg 106:135–138CrossRefGoogle Scholar
  10. 10.
    Carey LG (1967) Acute appendicitis occurring in hernias. A report of 10 cases. Surgery 61: 236–238PubMedGoogle Scholar
  11. 11.
    Thomas WE, Vowles KD, Williamson RC (1982) Appendicitis in external herniae. Ann R Coll Surg Engl 64: 121–122PubMedGoogle Scholar
  12. 12.
    Weber RV, Hunt ZC, Kral JG (1999) Amyand’s hernia: etiologic and therapeutic implications of two complications. Surg Rounds 22: 552–556Google Scholar
  13. 13.
    Luchs JS, Halpern D, Katz DS (2000) Amyand’s hernia: prospective CT diagnosis. J Comput Assist Tomogr 24: 884–886PubMedCrossRefGoogle Scholar
  14. 14.
    D’Alia C, Lo Schiavo MG, Tonante A, Taranto F, Gagliano E, Bonano L, Di Giuseppe G, Pagano D, Sturniolo G (2003) Amyand’s hernia: case report and review of the literature. Hernia 7: 89–91PubMedCrossRefGoogle Scholar
  15. 15.
    Priego P, Lobo E, Moreno I, Sanchez-Picot S, Gil Olarte MA, Alonsa N, Fresneda V (2005) Acute appendicitis in an incarcerated crural hernia: analysis of our experience. Rev Esp Enferm Dig 97:707–715PubMedCrossRefGoogle Scholar
  16. 16.
    Ofili OP (1991) Simultaneous appendectomy and inguinal herniorrhaphy could be beneficial. Ethiop Med J 29: 37–38PubMedGoogle Scholar
  17. 17.
    Franko J, Raftopoulos I, Sulkowski R (2002) A rare variation of Amyand’s hernia. Am J Gastroenterol 97: 2684–2685PubMedCrossRefGoogle Scholar
  18. 18.
    Greenberg J, Arnell TD (2005) Diverticular abscess presenting as an incarcerated inguinal hernia. Am Surg 71: 208–209PubMedGoogle Scholar
  19. 19.
    Yazici M, Etensel B, Gursoy H, Ozkisacik S, Ercus M, Aydin ON (2003) Infantile Amyand’s hernia. Pediatr Int 45: 595–596PubMedCrossRefGoogle Scholar
  20. 20.
    Marron CD, Khadim M, McKay D, Mackle EJ, Peyton JW (2005) Amyand’s hernia causing necrotizing fasciitis of the anterior abdominal wall. Hernia 9: 381–383PubMedCrossRefGoogle Scholar
  21. 21.
    Bamberger PK (2001) Revisiting Amyand’s hernia in the laparoscopic era. Surg Endosc 15:1051PubMedCrossRefGoogle Scholar
  22. 22.
    Orr KB (1993) Perforated appendix in an inguinal hernial sac: Amyand’s hernia. Med J Aust 159: 762–763PubMedGoogle Scholar
  23. 23.
    Hutchinson R (1993) Amyand’s hernia. J R Soc Med 86: 104–105PubMedGoogle Scholar
  24. 24.
    Saggar VR, Singh K, Sarangi R (2004) Endoscopic total extraperitoneal management of Amyand’s hernia. Hernia 8:164–165PubMedCrossRefGoogle Scholar
  25. 25.
    Vermillion JM, Abernathy SW, Snyder SK (1999) Laparoscopic reduction of Amyand’s hernia. Hernia 3:159–160CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • H. Sharma
    • 1
  • A. Gupta
    • 2
  • N. S. Shekhawat
    • 2
  • B. Memon
    • 1
  • M. A. Memon
    • 1
    • 3
  1. 1.Department of SurgeryWhiston HospitalMerseysideUK
  2. 2.Department of General SurgerySawai Man Singh Medical CollegeJaipurIndia
  3. 3.LancashireUK

Personalised recommendations