Amyand's hernia: an uncommon encounter of the appendix in an inguinal hernia

¹Department of Shalyatantra, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, DMIHER, Wardha, Maharashtra, India

^&Corresponding author
Devesh Nagpure, Department of Shalyatantra, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, DMIHER, Wardha, Maharashtra, India

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Amyand's hernia, an uncommon type of inguinal hernia containing the appendix within the hernial sac, was initially documented by Claudius Amyand in 1735 following appendectomy through an inguinal hernia. This condition affects individuals ranging from 3 weeks to 92 years of age, with a prevalence of 0.19%-1.7% among all hernia cases. It is observed three times more frequently in children than in adults because of the open processus vaginalis in pediatric patients. The occurrence of appendicitis within an inguinal hernia is even less common, with an incidence of 0.07-0.13%. Preoperative identification of an Amyand's hernia is challenging and is typically discovered incidentally during surgery. A 45-year-old male presented with a 30-year history of groin discomfort and a right inguinal enlargement. Physical examination revealed irreducible swelling with a positive cough impulse, whereas ultrasonography confirmed bilateral inguinal hernias, chronic hydroceles, and varicoceles. Laboratory test results indicated liver dysfunction (SGOT, 159 IU/L; SGPT, 68 IU/L) and compromised kidney function (creatinine 3.2 mg/dL, urea 105 mmol/L). During hernioplasty, a non-inflamed appendix was identified in the hernia sac, so an appendectomy was not performed. Prosthetic mesh repair was completed, and the patient's postoperative course was uneventful. The final diagnosis was an Amyand's hernia. The differential diagnosis for a groin bulge encompasses hernia, lymphadenopathy, lymphoma, metastatic neoplasm, hydrocele, epididymitis, testicular torsion, abscess, hematoma, femoral artery aneurysm, and an undescended testicle.

Figure 1: A) right-sided inguinal hernia sac containing bowel loops, protruding through the abdominal wall in the inguinal region; B) right-sided inguinal hernia sac containing the appendix, a rare presentation known as Amyand's hernia