Acute Tip Appendicitis Contained within a Right Sided Hernia (Amyand芒聙聶s Hernia):
Abstract
Abstract: This patient may be a 64 year old male with
a PMH of depression, anxiety, COPD, gastritis, and
former right hernia repair who presented to the ER
with one day of right groin pain that occurred sud-
denly the night before. He has never experienced
pain like this before and over the counter analgesics
didn’t relieve the pain. Patient states that the pain is
associated with a small budge in the right groin that
is tender to palpation [1]. On physical exam patient
had a soft and non-tender abdomen. An exquisitely
tender 2cm x 2cm palpable nodule in the right groin
was noted.
Image Article: This patient may be a 64 year old male
with a PMH of depression, anxiety, COPD, gastritis,
and former right hernia repair who presented to the
ER with one day of right groin pain that occurred
suddenly the night before. He has never experienced
pain like this before and over the counter analgesics
didn’t relieve the pain. Patient states that the pain is
associated with a small budge in the right groin that
is tender to palpation [1]. On physical exam patient
had a soft and non-tender abdomen. An exquisite-
ly tender 2 cm 2 cm palpable nodule in the right
groin was noted. CT scan of the abdomen showed
a right sided inguinal hernia containing the appen-
dix with acute tip appendicitis. Inguinal hernias con-
taining the appendix are rare and are mentioned as
an Amyand hernia. These are usually found during
routine inguinal hernia repairs and are a curiosity for
the operating surgeon, but there is little change in
the operative management of an open hernia repair
when the appendix is easily reducible. Rarer still is
the finding of acute appendicitis contained within
an inguinal hernia (Figure 1). This finding compli-
cates the management and challenges the surgeon’s
creativeness [2]. The standard of care for acute ap-
pendicitis is laparoscopic removal of the appendix.
Whereas the standard of care for inguinal hernia re-
pair is reduction of the hernia sac and mesh repair. A
mesh cannot be used in the setting of inflammation,
as such is that case with acute appendicitis.
surgery-emergency-medicine-appendicitis-inguinal
Figure 1: Acute appendicitis within the inguinal ca-
nal.
In this case, the acute appendicitis was the more
pressing pathology. It was decided to approach via
the standard laparoscopic method used for acute ap-
pendicitis. The hernia was easily reduced from the
abdominal cavity and the appendix was excised in
the usual manner. Pathology report showed acute
appendicitis [3]. Due to the acute inflammation, the
decision was made to not repair the hernia, and in-
structed the patient to return for follow-up where an
elective inguinal hernia repair with mesh would be
planned (Figure 2).
