Management of Amyand's Hernia: A Case Report

Abstract

Abstract Introduction: 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. There are no standardized protocols available for managing this condition, and diagnosis is usually made intraoperatively as presentation and workup may give no indication of the presence of the appendix in the sac. Due to the rarity of the disease and non-availability of standardized treatment protocols, decisions may be taken that might lead to increased patient mortality. Presentation of the Case: 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 excellent outcome and good healing was seen on follow-up. Discussion: 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. Conclusion: This case report presents Amyand’s hernia which presented as an unremarkable irreducible right inguinal hernia which was diagnosed intraoperatively, classified as Type 1 Amyand’s hernia.