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Table of Contents
CASE REPORT
Year : 2011  |  Volume : 5  |  Issue : 2  |  Page : 62-64

Amyand's hernia: A rare occurrence


1 Department of Plastic Surgery, Sheri-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
2 Department of Cardiovascular and Thoracic Surgery, Sheri-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
3 Department of Opthalmology, Sheri-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
4 Department of Health, Sheri-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India

Date of Web Publication17-Feb-2012

Correspondence Address:
Mohd Lateef Wani
Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.92955

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   Abstract 

Claudius Amyand, Surgeon to King George II, was the first to describe the presence of a perforated appendix within the hernial sac (in 1735) of an 11-year-old boy who had undergone successful appendicectomy. Amyand's hernia is an inguinal hernia with an appendix involved. It is a rare condition. The chance finding of the vermiform appendix lying within an inguinal hernia occurs in approximately one percent of cases of inguinal hernia. Preoperative diagnosis is difficult. If additional pathologies exist, the diagnosis is more troublesome. We aimed to present a patient with Amyand's hernia which is rare in the literature

Keywords: Amyand′s hernia, appendicitis, inguinal hernia


How to cite this article:
Khan TS, Wani ML, Bijli AH, Wani SN, NU, Irshad I, Shaheen N, Khan HA. Amyand's hernia: A rare occurrence. Ann Nigerian Med 2011;5:62-4

How to cite this URL:
Khan TS, Wani ML, Bijli AH, Wani SN, NU, Irshad I, Shaheen N, Khan HA. Amyand's hernia: A rare occurrence. Ann Nigerian Med [serial online] 2011 [cited 2019 Aug 24];5:62-4. Available from: http://www.anmjournal.com/text.asp?2011/5/2/62/92955


   Introduction Top


Claudius Amyand, Surgeon to King George II, was the first to describe the presence of a perforated appendix within the hernial sac in 1735 of an 11-year-old boy who had undergone successful appendicectomy. Since then, the presence of the appendix within an inguinal hernia has been referred to as "Amyand's hernia", and still remains a rare occurrence. We present such a case of Amyand's hernia in a one year old boy and briefly review the literature on the topic.


   Case Report Top


A one year old male child, first in birth order, with normal developmental milestones was referred from a peripheral heath care centre in Kashmir as a case of incarcerated right inguinal hernia. The patient was admitted in the Accident and Emergency Department. After preliminary examination of the child; incarceration of the hernia was confirmed by finding a right, tender, irreducible indirect inguinal hernia. Routine Laboratory and Radiological investigations were done which were normal. After repeated examination, it was observed that the hernia did not reduce by itself and it remained persistently tender. The decision for surgery was made to prevent obstruction and possible strangulation of the hernia. Patient was operated under general anaesthesia. Operation of the patient revealed inflamed cecum and appendix as the contents of the hernia sac [Figure 1] and [Figure 2]. The cecum was free and did not form the wall of the sac. Appendicectomy was performed and the cecum was pushed back into the abdominal cavity through the dilated internal ring which was then closed by purse string suture. The postoperative period was uneventful and the child was discharged on 4 th post operative day.
Figure 1: Figure Showing appendix as content of hernia of the patient in the case report

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Figure 2: A picture showing again appendix as content of hernia of the patient in the case report

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   Discussion Top


Claudius Amyand, Surgeon to King George II, was the first to describe the presence of a perforated appendix within the hernia sac in 1735 of an 11-year-old boy who had undergone successful appendicectomy. [1] The term Amyand's hernia is used for depicting the condition of non-inflamed appendix, inflamed appendix or perforated appendix within an inguinal hernia. [2] Its accurate diagnosis can be substantiated only with high clinical suspicion, since the symptoms associated with this disease state vary considerably. The most common clinical presentation involves rapidly progressing swelling, tenderness over the inguinal region, evocative of a strangulation or incarceration in the absence of radiographic evidence of obstruction. [3] In the emergent conditions, differential diagnosis should include strangulated or obstructed hernia, strangulated omentocele, Richter's hernia, testicular tumor with haemorrhage, acute scrotum, inguinal adenitis and epidydimitis. [4] Weber and colleagues presumes that the inflammatory swelling may lead to incarceration with consequent impaired blood supply. [5] The pathological mechanism of appendicitis in cases of Amyand's hernia is still a controversial subject. It may be due to inflammatory swelling but the size of the deep ring and the amount of content protruding through it, which causes strangulation, may play an important role.

The occurrence of herniated appendices is mostly reported in a right inguinal hernial sac, probably as a consequence of the normal anatomical position of the appendix, and also because right sided inguinal hernias is more common than left sided hernias. [6] An extensive literature search revealed very few reported cases of left sided Amyand's hernia. [7],[8],[9] The occurrence of left sided Amyand's hernia may be associated with the presence of a situs inversus or malrotation as an underlying cause. An abdominal computed tomography scan or X-ray examination should be performed to exclude these entities. [10] Most of the published cases have been reported as appendicitis incarcerated in a hernia. It is difficult to determine whether a primary visceral inflammation, which could be referred to as appendicitis, is the pathological mechanism, or if the primary event is strangulation of the herniated appendix, leading subsequently to ischemic necrosis and secondary inflammation. [11] The presence or absence of inflammation of the appendix is a very important determinant of appropriate treatment. If inflammation of the organ and incipient necrosis are present, a transherniotomy appendectomy should be performed. Associated intraabdominal abscesses, if present, may be dealt with either percutaneously or by open drainage. The majority of the authors agree that a normal appendix within the hernia sac does not require appendectomy, and that every effort should be made to preserve the organ found in the hernia sac for an uneventful postoperative course. [12],[13]

Finally, we conclude that the presence of the appendix in an inguinal hernial sac, referred to as "Amyand's hernia", is an uncommon entity. Despite its rarity, the fact that the majority of such cases present as a complicated inguinal hernia, making preoperative diagnosis difficult, demands that surgeons consider this condition in their differential diagnosis, so that the appropriate treatment is met out.

 
   References Top

1.Hutchinson R. Amyand's hernia. J R Soc Med 1993;86:104-5.  Back to cited text no. 1
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2.Sharma H, Gupta A, Shekhawat NS, Memon B, Memon MA. Amyand's hernia: A report of 18 consecutive patients over a 15-year period. Hernia 2007;11:31-5.  Back to cited text no. 2
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3.Davies MG, O'Byrne P, Stephens RB. Perforated appendicitis presenting as an irreducible inguinal hernia. Br J Clin Pract 1990;44:494-5.  Back to cited text no. 3
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4.Logan MT, Nottingham JM. Amyand's hernia: A case report of an incarcerated and perforated appendix within an inguinal hernia and review of the literature. Am Surg 2001;67:628-9.  Back to cited text no. 4
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5.Weber RV, Hunt ZC, Kral JG. Amyand's hernia: Etiologic and therapeutic implications of two complications. Surg Rounds 1999;22:552-6.  Back to cited text no. 5
    
6.Pellegrino JM, Feldman SD. Case report: Acute appendicitis in an inguinal hernia. N J Med 1992;89:225-6.  Back to cited text no. 6
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7.Gupta S, Sharma R, Kaushik R. Left-sided Amyand's hernia. Singapore Med J 2005;46:424-5.  Back to cited text no. 7
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8.Breitenstein S, Eisenbach C, Wille G, Decurtins M. Incarcerated vermiform appendix in a left-sided inguinal hernia. Hernia 2005;9:100-2.  Back to cited text no. 8
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9.Carey LC. Acute appendicitis occurring in hernias: A report of 10 cases. Surgery 1967;61:236-8.  Back to cited text no. 9
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10.Bakhshi GD, Bhandarwar AH, Govila AA. Acute appendicitis in left scrotum. Indian J Gastroenterol 2004;23:195.  Back to cited text no. 10
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11.Weir CD, Doan SJ, Lughlin V, Diamond T. Strangulation of the appendix in a femoral hernia sac. Ulster Med J 1994;63:114-5.  Back to cited text no. 11
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12.Bleichrodt RP, Simmermacher RK, van der Lei B, Schakenraad JM. Expanded polytetrafluoroethylene patch versus polypropylene mesh for the repair of contaminated defects of the abdominal wall. Surg Gynecol Obstet 1993;176:18-24.  Back to cited text no. 12
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13.Franko J, Raftopoulos I, Sulkowski R. A rare variation of Amyand's hernia. Am J Gastroenterol 2002;97:2684-5.  Back to cited text no. 13
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    Figures

  [Figure 1], [Figure 2]



 

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