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Highlights • It may be beneficial for patients with type 2 Amyand’s hernia to have an appendectomy with a tension free hernia repair using mesh. • Controversies still exist regarding the recognized classification system and treatment algorithm of Amyand hernia. • Controversy exists regarding the use of mesh for the treatment of type 2 Amyand’s hernia however we add to the argument of pro-mesh., Introduction An Amyand hernia is a rare disease where the appendix is found within an inguinal hernia sac. This rare entity is named after the French born English surgeon, Dr. Claudius Amyand. Inguinal hernias are one of the most common surgeries that a general surgeon performs with more than 20 million inguinal hernia repairs performed yearly worldwide. The incidence of finding an appendix within the hernia sac is rare, occurring in less than 1% of inguinal hernia patients and when complications arise such as inflammation, perforation, or abscess formation it becomes exceptionally rare with an incidence of about 0.1%. Presentation of case A 59-year-old male with a history of a previously reducible right inguinal hernia presented to the Emergency Department with acute abdominal pain, right groin mass. Computed tomography (CT) confirmed a right incarcerated inguinal hernia with herniated loops of bowel within the right inguinal region. Patient was subsequently treated with an appendectomy and tension free hernia repair with mesh with a successful outcome. Discussion The current generally accepted treatment algorithm for Amyand’s hernia is essentially contingent on the appendix’s condition within the hernia sac. Controversy exists regarding the application of mesh in type 2 Amyand’s hernia. More research is needed to provide surgeons with evidence-based standardized approaches for dealing with this unique situation. Conclusion This case report reviews a rare entity known as an Amyand’s hernia that presented as an incarcerated hernia that was diagnosed intraoperatively with an inflamed appendix, recognized as a type 2 Amyand’s hernia.

Giant inguino-scrotal hernias are those that extend below the midpoint of the inner thigh when the patient is in the standing position. There are three specific problems with management of these giant inguinal hernias: the “loss of domain” of the bowel, the high risk for recurrence, and the residual exuberant scrotal skin. A fundamental part in the treatment of patients with large hernias is represented by a careful preoperative investigation using MR and, if necessary, CT scan to exclude neoplastic pathology in the context. In this article, we describe the case of an obese patient suffering from Von Recklinghausen syndrome carrying a giant left inguino-scrotal hernia. A wide left inguinotomy partially extended to the scrotum was performed. In the hernia sac, the colon was completely collapsed and floating as it was entirely free from any intra-abdominal anatomic anchoring points. After a radical needful omentectomy, the trasversalis fascia and the internal inguinal ring were reconstructed with a polypropylene mesh placed in the pre-peritoneal-retro muscular space. A second wider polypropylene mesh was positioned above the muscular abdominal plane fixed to the pubic tubercle.

Introduction: Amyand's hernia is defined as the herniation of the whole or a part of appendix vermiformis into an inguinal hernia sac. Amyand's hernia is very rare, constituting about 1% of all inguinal hernia patients and 0.1% of all acute appendicitis patients. In one-quarter of Amyand's hernia patients, inflammatory changes are detected in appendix vermiformis. Detecting an appendiceal tumor in an Amyand's hernia sac is extremely rare, with only eight cases having been reported so far in the English literature. Case presentation: A 64-year-old man with an appendiceal carcinoid tumor inside an incarcerated Amyand's hernia sac. As the tumor was localized to the radix of the appendix, resection was carried out with the help of a linear-cutter stapler in a way to contain a part of the cecal wall. As the pathology examination revealed a carcinoid tumor infiltrating the periappendicular fatty tissue, right hemicolectomy was performed in a second session, in compliance with the oncological principles. No metastasis was present at the 24th month. Case reports published in the English literature regarding the Amyand's hernia with an appendiceal tumor were also analyzed in this study. Conclusion: Amyand's hernia containing an appendiceal tumor is an extremely rare clinical entity. Clinical manifestations mostly mimic the incarcerated hernia and thus accurate diagnosis is made incidentally during hernia surgery. The basic oncological principles apply for the approach to tumors inside a hernia sac. Keywords: Acute appendicitis, Amyand's hernia, Neuroendocrine tumor

The presence of the vermiform appendix, whether inflamed or not, inside a hernial sac is known as Amyand's hernia. Due to nonspecific signs, preoperative diagnosis is not common and requires a high index of suspicion along with awareness of this rare entity. It is more commonly mistaken for a strangulated or incarcerated inguinal hernia. Most cases of reported Amyand's hernia with appendicitis were in pre-term babies, infants, and post-menopausal women. We present a similar case in a 19-day-old, full-term baby presenting with inguinoscrotal edema, erythema, and without a palpable inguinoscrotal mass.

Amyand's hernia is a rare case of inguinal hernia where the hernia sac contains the appendix, and depending on the condition of the appendix, this type is classified into under types where the appendix can be normal, inflamed, or even perforated. Accordingly, the patient's condition can be good or bad. In our case, we have a 13-year-old child who suffers from abdominal pain and discomfort. He is referred to the emergency department with this complaint. By clinical and radiological examination, the presence of an inguinal hernia containing the appendix was found. Based on that, we performed emergency and investigative surgery in order to determine the condition of the appendix and whether there is suffocation or not. It was found by surgical opening that the hernia was incarcerated and this required excision of the appendix and repair of the hernia., Highlights • The crural hernia containing an inflamed appendix is a rare entity. • The clinical presentation depended on the inflammation extension inside the hernia sac. • The hernia repair must be performed without prosthetic material.

Amyand’s hernia is defined as the hernia with appendix normal, inflamed or perforated as content. 1% of inguinal hernias are Amyand’s and amongst them 0.1% contains inflamed appendix. Commonly encountered on right size due to anatomical position of appendix. Left Amyand’s is rare and associated with intestinal malrotation, situs invertus and mobile caecum. Here, we presented an interesting case of left irreducible hernia in 70 years old gentleman with no signs of acute obstruction or strangulation, patient underwent emergency laparotomy in which hernial sac contents were inflamed ileal loop, inflamed appendix and perforated caecum in 70 years old man is rare presentation and not reported in any literature as per our knowledge. Resection of inflamed bowel loop with ceacum done along with ileo ascending anastomosis with primary tissue repair done. Post-operative period was uneventful. Hernia sac contents are most of the time surprising and their management sometimes differ according to the content. Appendix in hernia sac is found in 1% of all hernia but lack of facility for the pre-operative diagnosis and varied presentation it is challenging to diagnose and operate accordingly.

Introduction and importance Congenital hernias occur 70% on the right side, 25% on the left side, and approximately 5% bilaterally. The finding of a congenital Amyand's hernia is of interest, especially in patients who do not present risk factors associated with connective tissue disorders, ascitic conditions, fetal developmental disorders or any condition that increases abdominal pressure. Case presentation Male patient, 6 months old, was brought to the pediatric surgery department due to a visible mass in the bilateral inguinal region, which protruded with crying. The parents report that he was a 36-week preterm, low birth weight, monochorionic monoamniotic twin with bilateral congenital inguinal hernia. An open herniorrhaphy was performed, showing a left communicating hydrocele with an indirect left inguinal hernia and right communicating hydrocele with indirect inguinal hernia containing cecal appendix with no signs of inflammation. Clinical discussion The most common clinical presentation is the presence of a reducible or irreducible mass, erythema and/or inguino-scrotal edema, irritability manifested by crying and recurrent pain in older infants. This condition may be associated with cryptorchidism, intrauterine structural developmental disorder, and the presence of fistulas. Appendectomy and traditional hernia reduction are the most common surgical approach. The evolution of this condition is favorable with extremely low complication rates. Conclusion Amyand's hernia in the neonate is a rare presenting condition, which frequently involves nearby structures with risk of inflammation, incarceration and perforation, so repair should be performed early., Highlights • Currently there are controversies in the approach of congenital inguinal hernias. • The overall outcome in the management of congenital hernia is favorable. • Traditional hernia management for congenital Amyand's hernia has good results.

Amyand’s hernia is described in the inguinal hernia sac as being the presence of an appendix vermiformis . It is a rare condition the incidence is about 1 per cent of all inguinal hernias. It is often diagnosed incidentally during inguinal hernia surgery. The main treatment method of Amyand’s hernia is surgery. We report a case of 63 years old man who presented with right inguinal groin bulge for 1 month with the previous repaired right inguinal hernia 5 years ago. On clinical examination revealed a 6 cmx8 cm firm, nontender, irreponible mass in the right inguinal region. He was diagnosed as right sided irreponible inguinal hernia. He was undergoing the elective surgery. Intra-operative, the hernia sac was laterally found in the inferior epigastric vessels and separated from sperm cord to deep inguinal ring. The hernia sac was opened. A non-inflamed appendix was seen. Appendectomy was performed, and the hernia was repaired by Halsted’s repair. Amyand’s hernia is a rare condition. The correct diagnosis is usually made intraoperative. Keywords: Amyand’s hernia, appendectomy, hernia repair, inguinal hernia.

Introduction and importance Amyand's hernia (AH) is a form of inguinal hernia which is consider as very rare and this type of hernia occurred up to 1% of all inguinal hernia cases. In this type of inguinal hernia, the content of hernia sac is appendix. Most patient with AH often remains asymptomatic and diagnosed intraoperatively. The diagnosis is challenging, since needs a high index of suspicion and imaging is key. Surgery is the mainstay management. We report a case of Amyand's hernia that was managed operatively in our medium complex public institution. Case presentation A 28 year's old man with normal body mass index (BMI) who had a history of right-side reducible linguino-scrotal swelling for 8 years, was admitted for elective right inguinal hernia repair. Two weeks back before admission, he noticed that swelling was slightly painful. Ultrasound of the abdomen reported normal findings. There was no history of abdominal pain and vomiting. Laboratory parameters were within normal limit. So, with a diagnosis of right sided partially reducible, incomplete, and indirect inguinal hernia, patient was operated for open hernia repair surgery, intra operatively we found dense adhesions within the sac, adhesions were released which revealed herniation of appendix into the inguinal canal. Appendix was mildly congested without gross evidence of inflammation. Hence, in view of noninflamed appendix, preperitoneal mesh (polypropylene) hernioplasty from Lichtenstein tension-free mesh repair was performed with appendicectomy. Postoperative period was uneventful, patient discharged at second day. Clinical discussion Amyand's hernia is very uncommon and characterized by the presence of the appendix in the hernia sac and it is 0.4–1% of all inguinal hernia cases, literature review also showed that incidence of Amyand's hernia is very rare, whereas only 0.1% of cases complicate into acute appendicitis due to late presentation and missed diagnosis. Conclusion Amyand's hernia (AH) makes up only a small proportion of most inguinal hernia cases, and its diagnosis is usually based on incidental finding intra-operatively. This condition may remain asymptomatic and behave like a normal inguinal hernia. Management of this type of hernia should be individualized according to appendix's inflammation stage, presence of abdominal sepsis and co-morbidity. With this approach it enables surgeons to manage more variations of Amyand's hernia. Laparoscopy for dealing Amyand's hernia is frequently diagnostic as well as therapeutic.

Introduction and importance Amyand's hernia is a rare type of inguinal hernia with an incidence of about 0.1% of all inguinal hernias with most in occurring in childhood. It is characterized by the presence of the vermiform appendix within the hernia sac. Case presentation We report the case of 40-year-old female who underwent inguino-labial hernia repair with an incidental finding of a normal appendix within the sac; this was not predicted by the pre-operative ultrasound scan. Clinical discussion We recommend that a detailed ultrasound scan be done for all patients with an inguinal hernia to help to manage the patient timeously and safely. Conclusion We present a rare condition in a 40-year-old female with a right inguinal hernia, an Amyand's hernia., Highlights • We report a case of Amyand's hernia in a 40-year-old female who underwent inguinal hernia repair. • A normal appendix was found in the sac and reduced without appendicectomy. Hernia repair without mesh was then performed. • Ultrasound scan is an excellent technique to evaluate the inguinal region but remains operator dependent.

Background Amyand's hernia, which is the presence of a normal or pathological appendix as a part of an inguinal hernia, is a rare clinical entity. We are reporting a very rare case of left-sided incarcerated Amyand's hernia with cecum and terminal ileum involvement. Case presentation A 4-year-old male child with left inguinal swelling of 2-year duration presented to Goba Referral Hospital. Two days before the patient visited our hospital, the swelling had become irreducible and caused severe groin pain. He had abdominal cramps, bilious vomiting, and mild abdominal distention, but passed feces. With the diagnosis of left-sided incarcerated inguinal hernia, the patient was investigated and prepared for surgical management. During the operative procedure, we identified the presence of appendix, cecum, and terminal ileum in the scrotum as the herniated component. After the sack was dissected, since there was also appendicitis, an appendectomy was performed. Then, high ligation of sack was done after cecum and ileum were reduced. After 3 uneventful postoperative days in the hospital, the patient was discharged. The patient was followed-up for 6 months, and he did not develop any complications. Conclusion Left-sided incarcerated Amyand's hernia with cecum and terminal ileum involvement is a rare clinical entity. Even though it is not common, appendicitis is one of the comorbidities that can be seen in patients with left-sided incarcerated Amyand's hernia with cecum and terminal ileum. Surgeons should have a high index of clinical suspicion and be aware of the potential involvement of appendix, cecum, and ileum as part of an incarcerated hernia during surgery, even in the left inguinal region. In this case, left-sided incarcerated inguinal hernia which involved inflamed appendix, cecum, and terminal ileum was successfully managed using an inguinal approach.

A 70d old infant who had reducible bilateral inguinal hernia was found to have acute bilateral scrotal swelling, erythema and tenderness without intestinal obstruction. Radiography and ultrasonography studies detected right side inguinoscrotal hernia. With a diagnosis of strangulated inguinal hernia on right side, exploration was done. Amyand's hernia and acute scrotal appendicitis were found. Appendectomy, bilateral inguinal herniotomy and scrotal fixation of testes were done. Scrotal appendicitis is an exceptionally rare cause of acute scrotum in young infants. Scrotal manifestations and scrotal complications of acute appendicitis in children are reviewed. This case stresses the need for emergency exploration of acute scrotum in which there is diagnostic dilemma.

Introduction: We report a rare case of low-grade appendiceal mucinous neoplasm (LAMN) within an incarcerated Amyand’s hernia. Case Report: he patient was admitted for an elective surgery due to an asymptomatic right-sided inguinal hernia. The operative findings were suggestive of an appendiceal mucocele. Appendectomy and herniorrhaphy were performed. The histology report revealed a low-grade appendiceal mucinous neoplasm. The patient had no clinical, biochemical or imaging signs of disease or hernia recurrence two years postoperatively. Conclusion: Surgical treatment involves appendectomy and hernia repair, which is performed without the implantation of synthetic mesh. The possibility of finding an incidental neoplasm should be considered during the surgery of an Amyand’s hernia.

Objective: Amyand’s hernia is described as the presence of vemiform appendix in the inguinal hernia sac and this condition is mostly incidental. The aim of this retrospective analysis was to evaluate the role of appendectomy and the mesh repair in the patients with Amyand’s hernia. Material and Methods: The clinical and laboratory findings, and treatment modalities of 12 patients with Amyand’s hernia among 6630 inguinal hernia patients who underwent surgery between January 2000 and May 2015, were retrospectively recorded. Moloney darn repair was performed in the patients who had inflamed appendix whereas Lichtenstein repair was performed in the patients who had non-inflamed appendix. Results: All of the patients were male with a mean age of 48.9 years (range 28-67 years). The most common symptoms and pain in the patients were swelling of the right inguinal area and pain. Three patients underwent emergency surgery due to incarcerated right inguinal hernia while remaining nine patients underwent elective surgical repair. The diagnosis of Amyand’s hernia was made during hernia surgery and routine appendectomy was performed in all patients. The only complication was the wound infection which was observed in the patient with perforated appendicitis (8.3%). The mean follow-up period was 80.4 months (range: 8-180 months) and there were no recurrent cases. Conclusion: The appendectomy can be performed safely in the patients with Amnyand’s hernia. The repair for inguinal hernia may provide satisfactory results in the absence of inflammation.

Amyand's hernia is a rare condition defined as the presence of appendix vermiformis within the hernia sac, and it constitutes 1% (0.19-1.7%) of all inguinal hernias. Inflammation of the appendix within the inguinal sac is rarer, comprising 0.1% (0.07-0.13) of all Amyand’s hernia cases. Although the clinical presentation of the disease varies depending on the inflammation of the appendix, the diagnosis is usually made during the operation. We herein present a 2-month-old male patient who underwent appendectomy during right inguinal herniotomy after visualization of the inflamed appendix adhering to the wall of the hernia sac.

The presence of an inflamed or non-inflamed appendix in an inguinal hernial sac is called Amyand’s hernia and it is a rare condition. The case is presented here of a 76-year-old Greek male with a known right reducible inguinal hernia, who presented at the hospital emergency department with the symptoms and signs of incarceration of the hernia. Intraoperatively, an inflamed appendix was revealed trapped in the hernial sac. To our knowledge this is the first case of Amyand’s hernia reported in a patient in Southwestern Greece.

Highlights • Presentation of a rare case of an Amyand’s hernia containing acute appendicitis and a perforated cecum. • Diagnosis was intraoperative and an ileocecectomy followed by Bassini hernia repair produced a favorable patient outcome. • Amyand’s hernias can contain a diverse range of features and presentations that can complicate diagnosis and treatment. • Our case underscores the importance of considering an Amyand’s and individualizing treatment based on operative findings., 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 acute appendicitis and a perforated cecum. Presentation of case A 46-year-old male with a right inguinal hernia of 2–3 year duration presented to our Emergency Department complaining of acute onset abdominal and groin pain. The patient was diagnosed with an incarcerated right inguinal hernia and underwent emergent surgical repair. Intraoperatively a reactive fluid was found within the hernia sac that prompted an exploratory laparotomy for suspected bowel perforation. The hernia was then found to contain an inflamed gangrenous appendix with an inflamed and perforated cecum. An ileocecectomy and enteroenterostomy was performed and the hernia defect was repaired without mesh. Discussion With an estimated incidence of only 1%, Amyand's hernias are rare and lack a clear evidence-based management scheme. Moreover, they can contain a diverse range of pathologic features and presentations that can complicate diagnosis and treatment. To avoid potential morbidity and mortality, the surgeon must consider an Amyand's hernia on his or her differential when operating on inguinal hernias and be aware of the associated presentations, complications, and management schemes. Conclusion There is a paucity of reports describing simultaneous appendicitis and cecal perforation within an Amyand's hernia. In our case, ileocecectomy and Bassini hernia repair with close follow-up led to a favorable outcome.