A case report of incarcerated inguinal hernia: Amyand’s hernia with adenocarcinoma tumor

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.