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An Amyand’s hernia is characterised as the presence of the appendix in an inguinal hernial sac. During laparoscopic cholecystectomy for gallbladder polyps, an incidental Amyand’s hernia was discovered in a 75-year-old female patient. On examination, the hernia contained an appendiceal mucocele but no evidence of perforation. An open appendicectomy with tension-free mesh repair was performed for the hernia. The histopathological report of the appendix was a low-grade appendiceal mucinous neoplasm (LAMN), an entity that is just as rare as an Amyand’s hernia. The patient had the right inguinal swelling for over 10 years but it was thought to be an inguinal intramuscular cyst as reported on a previous abdominal ultrasound. Mucocele of the appendix may have a benign or malignant appendiceal progress, leading to individualised diagnosis and treatment. We review an Amyand’s hernia with LAMN and discuss the asymptomatic tendency yet malignant potential of appendiceal mucoceles along with treatment strategies.

Although inguinal hernias are a common finding in premature infants, it is usually caused by the protrusion of the bowel through a persistent patent processus vaginalis. However, acute appendicitis in association with an inguinal hernia in this age group is a rare finding. This type of hernia is referred to as an Amyand hernia.

Resumen La hernia de Amyand es una entidad rara donde el apéndice se encuentra dentro del saco herniario inguinal. Se confunde con una hernia inguinal incarcerada. Tiene una incidencia menor al 1%, se asocia con complicaciones como inflamación, perforación o formación de abscesos.

Amyand’s hernia is rare condition defined as the inclusion of the appendixin an ingunal hernia sac, It is an uncommon and rare condition estimatedto be found in approximately 1 % of hernia. However, in just 0.08 %, thecondition is complicated by an acute appendicitis. It may present as atender inguinal or inguinoscrotal swelling. In patients presenting amyand’shernia with mechanical bowel obstruction, signs of acute appendicitis maynot be initially recognized. This was the case while our patient was insurgery, as signs suggestive of acute appendicitis were discovered and thepatient received appendectomy and herniotomy. Presently, We report a caseof Amyand’s hernia in a 9-month-old male, who presented as a left-sidedcongenital hernia with distended abdominal and pain in the left groin. Heunderwent appendectomy and herniotomy, which revealed that the herniasac containing elongated inflamed appendix appeared with some adhesionsto sac, lying in the inguinal canal.

Protrusion of the appendix within an inguinal hernia is termed an Amyand’s hernia. A systematic review of case reports and case series of Amyand’s hernia was performed, with emphasis on surgical decision-making. The English literature (2000–2019) was reviewed, using PubMed and Embase, combining the terms “hernia”, “inguinal”, “appendix”, “appendicitis” and “Amyand”. Overall, 231 studies were included, describing 442 patients. Mean age of patients was 34 ± 32 years (adults 57.5%, children 42.5%). 91% were males, while a left-sided Amyand’s hernia was observed in 9.5%. Of 156 elective hernia repairs, 38.5% underwent appendectomy and 61.5% simple reduction of the appendix. 88% of the adult patients had a mesh repair, without complications. Of 281 acute cases, hernial complications (76%) and acute appendicitis (12%) were the most common preoperative surgical indications. Appendectomy was performed in 79%, more extensive operations in 8% and simple reduction in 13% of cases. A mesh was used in 19% of adult patients following any type of resection and in 81% following reduction of the appendix. Among acute cases, mortality was 1.8% and morbidity 9.2%. Surgical site infections were observed in 3.6%, all of which in patients without mesh implantation. In elective Amyand’s hernia cases, appendectomy may be considered in certain patients, provided faecal spillage is avoided, to prevent mesh infection. In cases of appendicitis, prosthetic mesh may be used, if the surgical field is relatively clean, whereas endogenous tissue repairs are preferred in cases of heavy contamination.

Amyand's hernia is a rare inguinal hernia containing the appendix presenting mainly in male adults. The clinical presentation is usually without symptoms, however an inflammation can occur leading to strangulation, necrosis or rupture of the appendix. Differential diagnosis may be difficult including orchitis, testicular torsion, inflammation of the ovaries and bowel inflammation. We present a case of a 61 years old, male patient who was presented with persistent right abdominal pain. There was no medical history of previous hospitalization or surgery of the abdomen. Laboratory tests and radiological investigation with plain radiographs and ultrasound were not clear. A CT scan with contrast imaging was performed to reveal the diagnosis. Amyand's hernia is difficult to be revealed and a high index of suspicion is needed in order to promptly diagnose the hernia and proceed to the appropriate treatment. CT scan is critical contributing to the accurate depiction and to the classification of the hernia.

Highlights • The Amyand’s hernia is a rare disease. • Acute appendicitis in Amyand’s hernia is very very rare. • Acute appendicitis diagnosis in Amyand’s hernia is very difficult in the preoperative period. • The treatment of Amyand’s hernia is not standardized. • Appendectomy and herniorrhaphy under local anesthesia is a safe procedure., Introduction and importance Amyand hernia is a rare disease seen in approximatively 1% of all hernias, complications of it, like acute appendicitis, or perforated appendicitis are even more rare, about 0.1%. Its diagnosis is very difficult in the preoperative period: it is usually an incidental finding. Case presentation We report an unusual case of perforated gangrenous appendicitis with peri-appendicular abscess occurring in an irreducible Amyand’s hernia. An 80-year-old male, with chronic obstructive disease and pulmonary emphysema, atrial fibrillation, acute myocardial infarction, underwent urgent surgery, under local anesthesia, for right incarcerated inguinoscrotal hernia. He was found to have a perforated gangrenous appendicitis with peri-appendicular abscess within a right indirect inguinal hernia sac. Appendicectomy and Bassini’s hernia repair were performed under local anesthesia without any complications. Clinical discussion The treatment of Amyand’s hernia is not standardized. The current generally accepted algorithm for Amyand’s hernia is essentially contingent on the appendix’s condition within the hernia sac. Conclusion Appendectomy and primary herniorrhaphy, under local anesthesia, for type 3 of Amyand’s hernia, is a safe procedure and easy to perform and, if confirmed by further study, could be part of every surgeon’s knowledge.

The finding of a vermiform appendix within the peritoneal sac of an indirect inguinal hernia occurs in approximately 1% of cases. However, the presence of appendicitis within an inguinal hernial sac is found only in 0.08% of the general population.We present the case of a 58-year-old male patient that was admitted with abdominal pain associated with a small non-reducible right groin mass.To establish the correct diagnosis preoperatively, an abdominal and pelvic CT scan is mandatory.Acute appendicitis in an Amyand's hernia is a very rare entity that can be easily misdiagnosed preoperatively. CT is extremely useful in reaching the correct preoperative diagnosis.El hallazgo de un apéndice vermiforme dentro del saco peritoneal de una hernia inguinal indirecta ocurre en aproximadamente el 1% de los casos. Sin embargo, la presencia de apendicitis dentro de un saco herniario inguinal se encuentra sólo en el 0.08% de la población general.Presentamos el caso de un paciente masculino de 58 años que ingresa por dolor abdominal asociado a una pequeña masa inguinal derecha no reducible.Para establecer el diagnóstico correcto preoperatorio, es obligatoria una tomografía computarizada de abdomen y pelvis.La apendicitis aguda en la hernia de Amyand es una entidad muy rara que puede diagnosticarse erróneamente fácilmente en el preoperatorio. La TC es de gran utilidad para llegar al correcto diagnóstico preoperatorio.

9 children aged 4 to 14 years underwent a right-sided inguinal hernia repair, at the same time, a vermiform appendix was found in the hernial sac. All patients were hospitalized with a diagnosis of «Congenital right-sided inguinoscrotal hernia», bilateral hernias were not observed. Objectively, there were all signs of the disease, all hernias were reducible. The presence of the appendix in the hernial sac before the operation was not diagnosed either clinically or by ultrasound. The contents of the hernial sac had a thickened and long vermiform appendix, a greater omentum, and in two cases – a cecum of the type of sliding hernia. The children were operated on under general anesthesia: appendectomy and plastic surgery of posterior wall of inguinal canal were performed. No complications were observed in the postoperative period.

Highlights • Amyand’s hernia management remains controversial. • Use of mesh or not in Amyand’s hernia. • Role of CT scan in diagnosis of Amyand’s hernia. • Literature review of Amyand’s hernia and classification systems., Introduction An Amyand’s hernia is a rare disease where a vermiform appendix is found within an inguinal hernia sac. It is reported in the literature as having an incidence between 0.4%–1.0% of reported hernia cases. Typically, an incidental finding, Amyand’s hernia is consequently found more frequently intra-operatively rather than preoperatively. Presentation of case This case is a recount of a 56-year-old male, who presented in an outpatient setting for the evaluation of right inguinal pain and bulge. The patient was diagnosed with a vermiform appendix within the indirect hernia. The patient underwent elective repair of his inguinal hernia via Transabdominal Preperitoneal (TAPP) approach of the hernia with avoidance of appendectomy. Discussion An Amyand’s hernia presents a challenging diagnosis and the treatment algorithm is contingent on the condition of the appendix in individual cases. This case presents a Type 1 Amyand’s hernia that was repaired through laparoscopic approach using prosthetic mesh. The aim of this case study highlights the approach to surgical decision making in the diagnosis and treatment of Amyand’s hernia proposed in the current literature. Conclusion This case presents a rare condition known as Amyand’s hernia followed by a discussion on the epidemiology, diagnostic workup, and treatment options. Treatment is dependent on the state of the appendix found in the hernia sac and the clinical scenario. Comprehensive literature review shows that the true prevalence of this disease is lower than classically described and still has no clear standardized approaches.

Amyand's hernia (AH) is a rare condition in which the vermiform appendix is herniated into the inguinal sac regardless of whether the appendix appears normal or is inflamed. Most cases of AH are diagnosed intraoperatively at the time of inguinal hernia repair as its clinical diagnosis is difficult, and the role of computed tomography (CT) and other diagnostic imaging has not been described well in the literature. We report the case of a 79-year-old female who presented to the emergency department with nonspecific symptoms of nausea, vomiting, and constipation. Her symptoms were nonspecific, and physical examination suggested that she did not have a strangulated hernia or appendicitis, but the emergency CT scan of the abdomen showed a perforated appendix trapped in the sac of a right-sided inguinal hernia. Complicated appendicitis in an AH is a surgical emergency, and an accurate diagnosis is necessary for proper triage of patients and appropriate management. CT plays a significant role in revealing an unsuspected diagnosis of AH. Radiologists must be aware of this rare presentation of the appendix in an inguinal hernia sac and be familiar with AH subtypes.

ObjectiveAmyand's hernia is the presence of appendix in the hernia sac and is rarely seen. The diagnosis is mostly made incidentally during the operation performed due to the incarcerated inguinal hernia. It was aimed to present the experience about this rare pathology. Material and MethodAnalysis of 10 children with Amyand's hernia operated by a single pediatric surgeon between 2011 and 2017 was performed, retrospectively. Demographic features (age, gender), complaints, treatment methods, histopathological findings and postoperative results were evaluated.ResultsAll patients were male. The average age was 12.02 months (17 days-8 years). All had a right inguinal hernia. Emergency surgery was performed in 4 of the patients with an initial diagnosis of incarcerated inguinal hernia. The remaining 6 patients were diagnosed incidentally during elective hernioplasty. While 9 patients were treated with conventional hernia repair, only one patient underwent laparoscopy. Surgical findings included 7 normal appendices ve 3 inflamed appendices. Of 3 patients with appendix adhered to the hernia sac, 2 has appendicitis and 1 has lymphoid hyperplasia. Appendectomy was performed during inguinal hernia repair in 4 patients and hernia repair was performed in 6 patients without appendectomy. Recurrent hernias were not observed in any patients.ConclusionAmyand's hernia should be kept in mind in the differential diagnosis of patients with right inguinal hernia. The inflammation status of appendix adhering to the hernia sac should be carefully evaluated for an appropriate treatment decision., AmaçAmyand herni, inguinal herni kesesinde apendix vermiformisin varlığı ile karakterize nadir görülen bir herni türüdür. Çoğunlukla, inkarsere inguinal herni ön tanısı ile ameliyat edilen hastalarda tesadüfen tanı konulur. Bu nadir patoloji hakkındaki deneyimin sunulması amaçlandı.Gereç ve YöntemBu çalışmada 2011-2017 tarihleri arasında tek bir çocuk cerrahı tarafından ameliyat edilen on Amyand hernili çocuk hastanın retrospektif bir analizi yapıldı. Hastaların demografik özellikleri (yaş, cinsiyet), başvuru şikayetleri, tedavi yöntemleri, histopatolojik bulguları ve postoperatif sonuçları değerlendirildi.BulgularAmyand hernili tüm hastalar erkekti. Yaş ortalaması 12.02 aydı (17 gün-8 yaş). Hepsinde sağ inguinal herni mevcuttu. Hastaların 4’üne inkarsere inguinal herni ön tanısıyla acil cerrahi uygulandı. Geri kalan 6 hasta, elektif herni onarımı sırasında tesadüfen tanı aldı. Dokuz hastaya konvansiyonel herni onarımı yapıldı ve sadece bir hasta laparoskopi kullanılarak ameliyat edildi. Ameliyat bulguları 7 hastada normal apendiks ve 3 hastada inflame apendiksti. Apendiksi fıtık kesesine yapışık olan 3 hastanın ikisinde inflame apandisit birinde lenfoid hiperplazi saptandı. Dört hastada inguinal herni onarımı sırasında apendektomi, diğer 6 hastada apendektomi yapılmadan herni onarımı yapıldı. Hiçbir hastada tekrarlayan fıtık görülmedi. SonuçSağ inguinal hernisi olan hastaların ayırıcı tanısında Amyand hernisi unutulmamalıdır. Fıtık kesesine yapışan apendiksin inflamasyon durumu uygun bir tedavi kararı verebilmek için dikkatle değerlendirilmelidir.

Present the case of a 66-year-old male patient, with a history of right inguinal hernia, who was referred to the emergency room at the IESS de Chone Basic Hospital in the north of the Manabí province, Ecuador, with symptoms of Abdominal pain of more than 24 hours of evolution located in the right iliac fossa and inguinal region on the same side, in the physical examination the hernia was impossible to reduce, so he was taken to the operating room, in the intervention the cecal appendix was found swollen within the hernial sac, a condition known as Amyand's hernia.

Introduction: Amyand’s hernia (AH), a rare form of inguinal hernia, is characterized by finding the cecal appendix within the hernial sac. It is observed in 0.4–0.6% of inguinal hernias and complications such as acute appendicitis or perforated appendicitis can occur in 0.1% of the cases. The diagnosis is most often performed intraoperatively and its classification and management depend on the degree of appendix involvement. Case Report: A 53-year-old male patient presenting with right iliac fossa pain for two days associated with a mass in the right inguinal region. Physical examination revealed an irreducible right inguinal hernia, leading to the diagnosis of incarcerated inguinal hernia. Surgical treatment was proposed and performed. It evidenced the presence of the cecal appendix within the hernial sac with clear signs of inflammation (type II of the Losanoff and Basson classification). The cecal appendix was reduced, an appendectomy was performed via McBurney incision, and the right inguinal abdominal wall was repaired with no need for prosthetic mesh. Conclusion: Although AH is a rare condition, it should be considered among the differential diagnoses in cases of pain in the iliac fossa, inguinal swelling, and signs of infection.

Background Amyand’s hernia (AH) is defined as protrusion of the vermiform appendix within the sac of the inguinal hernia and usually misdiagnosed as obstructed hernia. It is more common in pediatric patients but there are controversies about dealing with the normally looking appendix in AH. The aim of this study is to present our experience in the management of AH and highlights the difference in dealing with normally looking appendix between pediatric and adult patients. Patients’ demographics, intraoperative, and postoperative outcome were reported and analyzed. Results This is a retrospective analysis of 12 pediatric patients aged between 15 days and 5 years presented with AH and operated in tertiary referral hospital over 10 years. This study included 10 males and 2 females. The median age at the operation was 7 months. Eleven patients were operated using conventional technique, and only one patient was operated using laparoscopy. In 11 patients, the appendix was looking normal and was reduced without appendectomy, and the hernia was repaired. Appendectomy was done in one patient presented with AH containing inflamed appendix. The postoperative course was uneventful in all cases. Conclusions There is a difference in the management of pediatric and adult patients presenting with AH, and appendectomy is not mandatory in normally looking appendix in pediatric patients.

Highlights • The type 2 myocardial infarction is an imbalance in the supply of oxygen to myocardium not related by an atherothrombotic disease which can be caused by an acute abdomen. • The Amyand’s Hernia with an myocardial ischemic pathology is notoriously uncommon in the surgical setting being of high mortality for the patient. • Although the holistic approach of patients with acute abdomen is the work of the surgeon, is important the fact of knowing the different patterns of clinical presentation of pathologies that not corresponding to the surgical specialty., Background Type 2 myocardial infarction (MIT2) is characterized by higher mortality rates compared to conventional type 1 infarction according to the European Society of Cardiology (ESC) in 2018. The purpose of this case is to identify appropriate therapeutic measures. A case of an Amyand’s Hernia that produced an MIT2 is described in this work. Case report A 77-year-old male was admitted to our emergency department for acute abdominal pain in the right lower quadrant associated with the presence of an ipsilateral inguinal hernia with signs of peritoneal irritation, while complaining of chest pain. A positive troponin indicated the presence of myocardial infarction. A laparotomy was performed with the finding of an incarcerated right inguino-scrotal hernia that contained the gangrenous and perforated cecal appendix (Amyand hernia type 3). The treatment consisted of surgical correction of the hernia, an appendectomy, antibiotics and support in the intensive care unit with a positive outcome. The diagnosis of Amyand hernia type 3 was established intraoperatively, and by imaging, confirming the presence of an MIT2 according to the criteria of the fourth definition of ECS infarction. Conclusion In the surgical environment it is strange to find patients who present with acute abdominal pain and a myocardial infarction at the same time. It is necessary for the consultant to recognize these two entities to make a correct diagnosis and provide timely treatment to reduce any possibility of patient mortality.

Introduction: Appendicite aiguë et hernie etranglée sont des urgences chirurgicales courantes dont le diagnostic et le traitement sont aisés. L’ existence d'un appendice inflammatoire ou non dans une hernie étranglée est rare. Ce syndrome est appelé hernie d'Amyand ou syndrome d’Amyand.Nous décrivons deux de ces rares présentations et proposons mise au point et traitement.Dans le premier cas, le diagnostic de syndrome Claude-Amyand a été posé avant l’intervention au moyen d’un CT-scanner abdominal. Une appendicectomie fut tout d’abord réalisée suivie de la cure de hernie dans un deuxième temps. Dans le deuxième cas, seul le diagnostic de hernie fut posé par échographie en préopératoire. La persistance d’un syndrome inflammatoire 4 jours après l’opération et d’un syndrome abdominal douloureux justifiait alors un Ct scanner qui démontrait la présence d’un plastron appendiculaire laissé en place lors de la première interventionDiscussion: Il est rare que l’appendice enflammé se glisse dans une hernie ou une éventration et favorise son étranglement. Le chirurgien doit être conscient que le sac herniaire peut contenir autre chose que l’intestin ou de l’épiploon non enflammé. En présence d’une pathologie herniaire associée à un syndrome inflammatoire, un CT pré-opératoire doit être réalisé. Nous proposons qu’une coelioscopie soit réalisée si l’examen du sac herniaire ne confirme pas l’impression radiologique Conclusion: La connaissance chirurgicale des complications potentielles liées à la prise en charge des hernies étranglées est primordiale pour la détermination de la stratégie opératoire, info:eu-repo/semantics/published

Amyand hernia (AH) is defined as protrusion of appendix or its entrapment within the inguinal hernia sac. It occurs rarely and difficult to diagnose before operation. The cause of amyand hernia is unknown but pressure by the sharp edge of the internal ring may cause pressure necrosis, inflammation and consequently appendicitis. We present a case of 3 years old child with asymptomatic right sided inguinal hernia. On exploration, we found a long appendix (10 cm) with small olive like (1.5 cm) mass at its tip, so we performed appendectomy along with herniotomy. The patient tolerated the operation well and was discharged with satisfactory condition 48 hours post-operation.

A 26-week-old extreme preterm boy presented with a right hemiscrotal abscess. An ultrasound of the scrotum suggested right epididymo-orchitis. The abscess was drained and appropriate intravenous antibiotics were initiated. One month later, he was diagnosed with a right sided irreducible inguino-scrotal swelling, confirmed as bilateral inguinal hernia with herniating bowel loop on ultrasonography. With this diagnosis, he was planned to undergo a bilateral herniotomy. Intraoperatively, an inflamed and perforated appendix was found herniating into the right sac. The tip of the appendix was adherent to the scrotal wall, where the pus was extruding out. Appendicectomy and bilateral herniotomy was done successfully and histopathology revealed acute appendicitis. Baby recovered well postoperatively. Owing to the fragile nature of tissues in neonates, accession of planes was challenging. Amyand’s hernia presenting as a scrotal abscess is extremely rare in newborn infants, and less than 5 cases have been reported till date.

A hernia is an abnormal protrusion of an organ or tissue from its containing cavity. Inguinal hernia is the most common type of abdominal hernias. The presence of the appendix within the inguinal hernial sac is a rare occurrence. We present the case of a 41-year-old man, with no previous surgical history, who presented to the emergency department with a right-sided painful groin swelling. The swelling was associated with nausea, vomiting, anorexia, and fever. Initial laboratory investigation revealed leukocytosis and elevated C-reactive protein and erythrocyte sedimentation rate. A computed tomography (CT) scan demonstrated the presence of an inflamed appendix with an inguinal hernia. The patient underwent laparoscopic repair of the hernia with appendectomy. The patient tolerated the procedure without any complications. Amyand hernia with acute appendicitis is a very rare surgical condition. Clinicians should have a high index of suspicion for Amyand hernia with appendicitis when they encounter a patient with groin mass with laboratory markers indicating an inflammatory process.

Amyand hernia is a rare presentation in inguinal hernias (less than 1% of cases with inguinal hernias) which is evidenced when in herniated masses the presence of inflamed appendix is ​​ascertained or not. It was named after a French surgeon, Claudius Amyand (1660-1740), who performed the first successful appendectomy in 1735, where he found an acute appendicitis in a herniated mass. Most cases are diagnosed intraoperatively, as an accurate preoperative diagnosis rarely becomes evident. Management is individual depending on the stage of inflammation of the appendix, the presence of abdominal sepsis and concomitant factors. The decision should be based on factors such as the patient's age, the size and anatomopathological shape of the appendix, and in the case of an inflamed appendix, standard appendectomy and retinal herniorrhage should be the gold standard of treatment. Amyand hernia is usually misinterpreted as a common incarcerata hernia. Symptoms that mimic appendicitis may appear. Treatment consists of a combination of appendectomy and hernia repair. The inflammatory status of the appendix determines the type of hernia repair and the surgical technique. Occasional appendectomy in the case of a normal appendix is ​​not recommended. Amyand hernia is a rare type of inguinal hernia in which the appendix is located in the hernia sac. We present a case of a recurrent incarcerated Amyand’s hernia with complicated appendicitis. The 78 old polymorbide patient with right-sided incarcerated recurrent hernia was emergently operated on and appendectomy and non-mesh hernioplasty performed, on the 3rd postoperative day for a heart attack he was placed cardio stimulator with uneventful outcome. Fifteen months follow up did not show complications or complaints.

Highlights • Patients with concomitant symptoms of appendicitis and inguinal hernia should have a diagnostic suspicion of amyand hernia. • Laparoscopy can be used as a diagnostic and therapeutic modality in amyand hernia patients. • Laparoscopy helps to better determine the degree of inflammation of the hernia sac to decide on hernia repair., Introduction Amyand hernia is a rare type of hernia in which the appendix is ​​located inside the hernia sac.Its diagnosis is very difficult in the Pre-operative period and it is usually presented as an intraoperative finding. Presentation of case A 21-year-old male who presented to our emergency department with peri-umbilical pain associated with nausea and vomiting. On examination he had a tenderness in the inguinal canal. He underwent diagnostic laparoscopy. Operative finding was amyand hernia with inflamed appendix in hernia sac. Laparoscopic appendectomy and tissue repair was performed for him. Discussion There are several preoperative diagnostic modalities for amyand hernia including abdominal CT scan and ultrasound. Diagnostic laparoscopy can be used as one of the diagnostic modalities for this type of hernia. Amyand hernia treatment includes appendectomy and inguinal hernia repair, which can vary depending on the severity of inflammation of the inguinal area. Conclusion based on our study another diagnostic modality in case of clinical suspicion of amyand hernia is diagnostic laparoscopy which is useful approach in all forms of incarcerated hernias to assess contents and avoid unnecessary laparotomy.

Purpose Amyand’s hernia is a rare hernia defined as an inguinal hernia that contains the appendix within the hernia sac. Current treatment of Amyand’s hernia remains controversial. Our study retrospectively reviewed 6 cases of Amyand’s hernia, aiming to provide a reference for the surgical treatment of Amyand's hernia. Methods Six patients diagnosed with Amyand’s hernia from September 2010 to May 2020 were retrospectively enrolled in our study. We summarized clinical data of six patients including the chief complaint, physical examinations, laboratory examinations, imaging examinations, surgical methods, and postoperative treatments and outcomes. Results The diagnosis of six cases with Amyand’s hernia was made during surgery. Two patients had normal appendixes whereas the remaining four patients had appendicitis. Two patients with normal appendix received tension-free mesh repair through the inguinal incision. Among those with inflamed or perforated appendixes, two received mesh repair and the other two did not. The discharge time after surgery of six patients was 9.8 ± 6.1 days. One patient suffered from a wound infection. No additional postoperative complications were detected. Conclusions Computed tomography and ultrasonography are helpful but limited in the definite diagnosis of Amyand’s hernia. The presence of a normal appendix does not require to be resected, but appendicectomy is necessary if the appendix is inflamed. The treatment of Amyand's hernia should be tailored based on the patient's condition and the type of Amyand's hernia.

First operated by Claudius Amyand in 1735. Amyand’s hernia is a rare presentation and accounts for only 1% of all inguinal hernias. Amyand’s hernia is described when the appendix is trapped within an inguinal hernia. In most cases, Amyand’s hernia is an incidental finding intra-operatively due to variable clinical manifestations, and features. Amyand’s hernia has variable theories explaining its pathophysiology besides having multiple proposed surgical approaches either via laparoscopic or open repair and with the latter being in a debate of pro and against mesh repair. We present a case of a sliding Amyand’s hernia in which the vermiform appendix and part of the cecum were adherents to the wall of a right inguinal hernial sac. Amyand’s hernia is a rare form of inguinal hernias and its presentation is widely variable. However, in most cases, it is non-complicated and is found as an incidental intraoperative finding. Many studies debate among different diagnostic and management approaches to serve a better outcome with fewer operative complications.

INTRODUCTION: An Amyand’s hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand’s hernia containing a suppurative appendix and omentum on a morbidity obesity patient , in order to improve our understanding of this disease, avoid misdiagnosis and share experience in the treatment. PRESENTATION OF CASE: A 46-year-old morbidity obesity male presented to our Emergency Department complained an acute onset abdominal pain near the right groin and the McBurney point with nausea and fever. The patient was initially diagnosed as acute appendicitis according to the laboratory tests and the clinical presentation. However, after a right groin hernia contained an inflamed appendix showed by the computed tomography scan, the final diagnosis of Amyand’s hernia was supported. Surgical treatment was then performed, and a right groin hernia was found to contain a suppurative appendix and omentum, intraoperatively. An appendectomy was performed, but the hernia was not repaired simultaneously considering the morbidity risks and surgically technical difficulty brought with the severe morbidity obesity. CONCLUSION: With an estimated incidence of only 1%, Amyand’s hernias are rare emergency case, lacking a clear evidence-based management scheme. Moreover, they can contain a diverse range of pathologic features and presentations that can complicate diagnosis and treatment. There is a paucity of reports describing the management of an Amyand’s hernia with appendicitis on morbidity obesity patients. In our case, we shared our surgical experience and the management of Amyand’s hernia on morbidity obesity patient should be tailored to individual’s condition.

Amyand’s hernia is an atypical and rare hernia characterized by the herniation of the vermiform appendix into the inguinal sac. Here, we report the case of a 60-year-old male patient presented with complaints of the right-sided reducible inguinal hernia. On exploration as an incidental finding, we encountered an Amyand’s hernia treated with appendectomy and hernioplasty without any complications. Hence, we should keep in mind to rule out Amyand’s hernia during hernioplasty.

The combination of an inguinal hernia containing the appendix, either infected or not, leads to another surgical entity, Amyand’s hernia. Its frequency is reported at 1% of all inguinal hernias. Clinical preoperative diagnosis is challenging due to its resemblance to common inguinal hernias. As this type of hernia may be misinterpreted as a ruptured or inflamed appendix, imaging techniques may detect and guide surgical decision making. The treatment methodology may include appendectomy through inguinal sac or laparotomy or even simple reduction and hernioplasty, depending on the appendix inflammation status. The objective of this paper is to display a case of an Amyand’s hernia in a 70-year-old man with our therapeutic approach and to highlight the main points of the literature.

Introduction: Amyand’s hernia is an extremely rare and atypical hernia that is difficult to diagnose clinically characterized by the herniation of the appendix into the inguinal sac. The aim of this report is to describe a case of Amyand’s hernia and highlights the importance of early CT scanning in reaching the exact and early diagnosis of Amyand’s hernia. Case report: We present a rare case of a 69-year-old female patient with a history of intermittent pain in the right inguinal region is see at the emergency surgical clinic. The patient underwent a CT scan of the abdomen and a small pelvis, and an inflamed appendix was diagnosed. The inflamed appendix is herniated in the inguinal hernia sac. Computed tomography was the only modality to diagnose the hernia sac contents preoperatively. Discussion: The reported incidence of Amyand’s hernia is less than 1% of all adult inguinal hernia cases. Acute appendicitis in Amyand’s hernia is even less common, with 0,1% of all cases of acute appendicitis. This hernia may be present without symptoms until the inflammation of the appendix may lead to incarceration, strangulation, necrosis, perforation, or rupture. Early symptoms include tenderness and inguinal swelling. Conclusions: Computer tomography helps make an accurate and timely diagnosis of Amyand’s hernia, thus avoiding complications from delayed surgery.

Amyand hernia is defined as hernia containing appendix as content which can range from being normal or inflamed to being gangrenous and perforated. Its occurrence is three times commoner in infants and it occurs more frequently on right side. Exact surgery to be performed in such cases is subject to the type of amyands hernia present ranging from herniorraphy and hernioplasty to laparotomy. Herein, we report the unusual case of a 70years old man who presented with left sided amyands hernia. Conclusion: Hernia is defined as protrusion of a viscus or part of viscus through an abnormal opening in the wall of its containing cavity. Inguinal hernia is the most commonly occurring variety usually containing gut or omentum. Amyand’s hernia is a rare variety of inguinal hernia comprising 1% of all presentations.1 Its defined by presence of appendix as its content which can be either normal or inflamed.2 Its three times commoner in infants and occurs more on right side.3 Here we report a unique case of left sided Amyand’s hernia diagnosed per operative in seventy year old man.

Repair of inguinal hernia is one of the most common procedures in general surgical practice. Amyand's hernia is an unusual condition that entails the presence of the appendix in the hernial sac. In this case, we present a rare combination of Type II Amyand's hernia and sliding hernia that was discovered during elective hernial repair in a male patient. The inflamed appendix was removed, and tension-free Lichtenstein repair was performed. Postoperative recovery was uneventful with no recorded complications or recurrence of hernia. Amyand's hernia is usually diagnosed intraoperatively. The association of a sliding component with Amyand's hernia did not alter the management plan. The use of synthetic mesh in Type II Amyand's hernia is safe and feasible, despite the recommendation to avoid prosthetic repair in this type of hernia.

For citation: Sliepov OK, Ponomarenko MV, Markevich OV, Skiba OS, Shipot OG. (2019). A rare clinical case of surgical treatment of Amyand’s hernia in a preterm newborn baby. Paediatric Surgery. Ukraine. 3(64): 42-46. doi 10.15574/PS.2019.64.42 Article received: May 08, 2019. Accepted for publication: Sep 15, 2019. The article presents a rare clinical case of surgical treatment of a premature newborn baby with a birth defect – the right Amyand’s hernia. One-stage radical surgical treatment was performed: appendectomy and right-sided inguinal hernia repairing. The result of the surgical correction of the presented malformation is good. After treatment the child recovered. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee (LEC) of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Left Amyand Hernia (AH) is a very rare form of inguinal hernia. It presents commonly as an incarcerated inguinal hernia and intraoperative diagnosis is usually the rule. This is a report of a 7 months old male infant presenting with bilateral inguinal hernia, including a complicated left AH, with associated mobile caecum and meatal stenosis. He had bilateral herniotomy, transhernial appendectomy and meatotomy and did well post-operatively. A comprehensive comparative review of all 35 reported cases of left AH in the literature was undertaken alongside this report.

Highlights • An appendix incarcerated in the inguinal hernia is defined as Amyand’s hernia. • Preoperative diagnosis of Amyand’s hernia is feasible with ultrasound and CT. • Laparoscopy for diagnostic and therapeutic purposes has been on an upward trajectory. • A potential total laparoscopy treatment strategy for Amyand’s hernia was proposed, with fair outcomes., Introduction The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand’s hernia. It is even rarer with complicated appendicitis. Formerly it was treated via an open groin approach; recently there are new trends involving the use of laparoscopy for reduction and management of appendix. Conversely the role of laparoscopy in the following hernia repair was less discussed, with no standard care. We reported a case of Amyand’s hernia complicated with appendix which was managed via a total laparoscopic strategy. Presentation of case A 49-year-old male presented with right groin mass with progressive pain for 3 days. Physical exams revealed incarcerated right inguinal hernia. Amyand's hernia with acute appendicitis was diagnosed preoperatively via computed tomography (CT). Emergent diagnostic laparoscopy was performed. Appendix was reduced, with appendectomy justified for signs of appendicitis. An interval total extraperitoneal (TEP) hernioplasty was performed 3 month later, with no adverse events postoperatively. Discussion In virtue of previous literature, we proposed a total laparoscopic strategy for Amyand’s hernia which consists of transabdominal diagnostic laparoscopy, management of appendix, and either immediate or elective laparoscopic hernioplasty, based on status of appendix. Conclusion This laparoscopic treatment strategy is feasible for Amyand’s hernia, with minimized risk of surgical site infection (SSI), fair recovery and cosmesis.

An Amyand’s hernia is an inguinal hernia that contains vermiform appendix. De Garengeot’s hernias are similar; however, in this case the appendix is within a femoral hernia. Both types of hernia are rare, and those hernias associated with appendicitis, perforation, or abscess are even scarcer presentations. The treatment of Amyand’s hernia and De Garengeot’s hernia is not standardized. Generally, hernia repair is performed but disagreement remains regarding the use of mesh and performing appendectomy. This case series describes two individuals with appendicitis presenting to one emergency department within a 24-hour time frame. One case is of a patient with Amyand’s hernia and another case is a patient with De Garengeot’s hernia with an adjacent abscess. Both individuals were managed with appendectomy and hernia repair without the use of mesh.

The finding of a vermiform appendix in the case of an inguinal hernia that extends below the midpoint of the inner thigh when the patient is in a standing position is defined as giant left-sided Amyand’s hernia. It is a very rare case and significantly challenging in terms of preoperative diagnosis and surgical management. Here we present our experience with a case of a giant left-sided Amyand’s hernia that was followed up for 2 months.

Amyand’s hernia, presence of the appendix within an inguinal hernial sac, is a rare condition. We report a case of a 68-year-old woman who presented during the COVID-19 pandemic with an acute right groin pain due to a tender incarcerated inguinal hernia. Cross-sectional imaging confirmed an Amyand’s hernia. She proceeded to open appendectomy via the inguinal canal and primary suture repair of her inguinal hernia. Patient was discharged the following day. Surgical management of Amyand’s hernia varies depending on the resources, clinical findings and personal experience. In our opinion and experience, open hernia reduction, appendectomy and primary tissue repair repairs the most effective and appropriate approach especially during the COVID-19 pandemic.

Amyand’s hernia is a rare classification of inguinal hernia where the vermiform appendix is located within the hernial sac. This case report discusses a patient presenting with abdominal and groin pain shown to be an Amyand’s hernia complicated by acute appendicitis on computed tomography. The patient was treated with a two-stage approach, involving transabdominal laparoscopic appendectomy and elective laparoscopic hernioplasty after recovery. As some controversy exists regarding the timing of appendectomy and hernioplasty, we examine the benefits of the interval approach in the reduction of postoperative infection risk compared with a concurrent approach in patients presenting with Amyand’s hernia complicated by appendiceal inflammation.

Highlights • Amyand’s hernia is an inguinal hernia that contains vermiform appendix in its sac. Diagnosis is, in the majority of cases, intrasurgical. • Many authors suggest that prophylactic appendectomy is not necessary when the appendix is found without signs of inflammation. • Adenocarcinoma of the appendix is extremely rare neoplasm. Right hemicolectomy is the treatment of choice for such tumors. • The evidence concerning hernial repair without mesh in the context of potential contamination is controversial., Introduction Inguinal hernia is one of the most common surgical problems, often posing technical challenges even to expert surgeons. Amyand’s hernia (AH) is an inguinal hernia whose sac contains the vermiform appendix. Primary appendiceal neoplasms are rare. We report the case of an appendiceal adenocarcinoma within an Amyand’s hernia, presenting as an incarcerated right inguinal hernia. Presentation of case A 87-year-old male presented in the emergency department due to a persistent right inguinal pain. Clinical examination revealed a tender right groin mass. Under the diagnosis of an right inguinal hernia, an operation was taken. Intraoperatively, an inflamed appendix and a part of the cecum were found in the hernia sac. The operation was completed with an ileocecal resection and a modified Bassini hernia repair. Histological examination revealed a adenocarcinoma of the appendix. Discussion Amyand’s hernia is an inguinal hernia that contains vermiform appendix in its sac. It consists 1% of all inguinal hernias while appendicitis in an Amyand’s hernia accounts for 0.1% of all appendicitis cases. Adenocarcinomas of the appendix are even rarer, accounting for 0.2% to 0.5% of all intestinal malignancies, and 4%–6% of primary appendiceal neoplasms. Diagnosis is usually established intraoperatively. Conclusion A malignancy of the appendix should always be in the differential diagnosis of a right inguinal mass, in order to provide optimum surgical treatment.

Testicular ectopia is an aberrant deviation of the migration of the testis from its usual path of descent into the scrotum. Of the forms of ectopic testis, the penopubic (also called pubopenile) type is one of the least common; in this case, presented as an obstructed hernia. We report a rare case of penopubic testicular ectopia with bilateral cryptorchidism in a 17-year-old boy who presented to the emergency room with right obstructed inguinal hernia. Intraoperative findings included bilateral cryptorchidism, hernia sac with right undescended testis and normal vermiform appendix, a left penopubic testis abutting the hernia sac. Both testes had separate epididymides and adequate length of vasa deferentia and were transposed into their respective hemiscrotum via an open inguinal approach. The patient had an uneventful recovery. Penopubic testicular ectopia can present as obstructed Amyand’s hernia. Early open groin exploration with orchidopexy was satisfactory.

Amyand's hernia (AH) is a rare form of an inguinal hernia where the vermiform appendix is found within the hernia sac. Diagnosis is usually based on incidental finding intraoperatively. The AH makes up a small proportion of all inguinal hernia cases, and concurrent acute ischemic complication makes up an even smaller subset. We present an 85-year-old male who was referred to general surgery services for a growing mass on his right lower quadrant in the inguinal region. This was non-tender on palpation, and therefore there was no suspicion of ischaemic complications. An open hernioplasty was performed with resection of the appendix. The AH in this patient would be conventionally classified as type 1 AH, which would be managed with hernial reduction and mesh repair. The anatomical variance in our patient's AH increased the risk for hernial incarceration; hence an appendectomy was also performed despite the absence of acute appendicitis. This approach was also deemed necessary to avoid the recurrence of hernia due to its large size and adhesions within the hernial sac. This study reports a novel management approach for an incidentally discovered type 1 AH. It highlights that there is a lack of management guidance for the AH anatomical variants. The classification and management for AH under the conventional Losanoff and Basson's AH classification model have limitations that can be amended by incorporating the physical dimensions of the AH. This approach will enable surgeons to recognize and manage more variations of AH while mitigating downstream complications.

Amyand’s hernia is the presence of the vermiform appendix within an inguinal hernia sac. It is rare, and even rarer is the presence of acute appendicitis within the sac. It presents in a variety of different ways and often is only diagnosed intra-operatively. We present the case of a 90 year old male with extensive co-morbidities presenting with right upper quadrant pain, who on computed tomography scan of the abdomen, had acute cholecystitis alongside acute appendicitis within Amyand’s hernia. Ultimately given his co-morbidities, a conservative approach with prolonged antibiotic therapy was adopted, with a successful outcome. This case highlights that although classifications for treatment of Amyand’s hernia exist, careful clinical assessment is warranted in each case to ensure optimal outcome based upon individual circumstances.

Background Amyand’s hernia is a rare condition approximately 0.4–0.6% of all inguinal hernias. Although rare, the Amyand’s hernia is worthy of discussion since the variable presentation that make clinical challenge to diagnose especially in infant. A mesenteric chylous cyst is rare disease and has not been reported in Amyand’s hernia. Case presentation We report an unusual case of Type II Amyand’s hernia with an enlarging chylous mesenteric cyst on the retrocaecal in the anulus into canalis inguinalis. A-2-months old infant presented with enlarging mass in the right scrotal. During laparotomy exploration, we found inguinal sac with intestinal and appendix content in the sac. In the edge site of the sac we found enlarging of mesenteric cyst on the retrocaecal in the anulus into canalis inguinalis. Based on the histopathology examination, the morphological feature is suitable for mesenteric chylous cyst appearance. Conclusion Presentation of mesenteric chylous cyst is rare, and there was no report about it in Amyand’s hernia. This unusual presentation should be considered by the surgeon, especially pediatric surgeon, in Amyand’s hernia cases.

An inguinal hernia is one of the most common surgical conditions accounting for both elective as well as acute admissions. Amyand's hernia is a rare entity of inguinal hernia, which represents a very small percentage of all inguinal hernias. While in most cases it is an incidental finding encountered during routine repair of an inguinal hernia, in other cases, it might be the reason for acute presentation. We are presenting a case of a six-week-old male who was found intraoperatively to have not only the appendix but also the caecum in the hernia sac. We believe that a preoperative groin ultrasound scan would aid clinical diagnosis and facilitate surgical planning in these cases.

Amyand’s hernia in a child is a very rare entity. It poses a diagnostic challenge to the surgeon due to its variety of presentation. We are presenting a case of a 5-year-old child who presented to our institute with right-sided irreducible inguinal hernia. On exploration, the content of the hernia was caecum with normal appendix for which herniotomy with appendectomy was done.

Amyand's hernia is an exceedingly rare condition in which the appendix is found in an inguinal hernia. The appendix can be normal, inflamed, infected, or perforated. Here, we present a case of perforated appendicitis in an Amyand's hernia in an extremely preterm infant with subsequent post-operative complications including necrotic bowel and venous thrombosis of the mesentery. This article stresses the importance of complications that can arise in Amyand's hernia, especially in an extremely preterm infant.

Amyand’s hernia describes the presence of an appendix within the sac of an inguinal hernia. Both an inflamed and non-inflamed appendix within the hernia sac have been reported in the literature with various recommendations on approach to management. However, a tumour of the appendix is a rare finding in an Amyand’s hernia. We hereby report the unusual presentation of a fibroma of the appendix complicating the rare Amyand’s hernia in a young man with a scrotal mass.