Amyand's hernia and associated acute appendicitis: A case report

Introduction: Amyand's hernia is incarceration of vermiform appendix within inguinal hernia. Amyand's hernia associated with acute appendicitis is rare. Case presentation: A male in his 5th decade of life presented with enlarged right reducible inguinal scrotal swelling and each episode of incarceration relieved manually. Background history of a movement disorder. Ultrasound reported right inguinoscrotal hernia with bowel content but no obstruction seen with plain abdominal x-ray. Elective right open inguinoscrotal repair was done. Intraoperative findings included enlarged superficial ring, enlarged hyperemic appendix in indirect hernia sac adhering to caecum. After appendectomy, the sac was transfixed above caecum. Hernioplasty was done with a polypropylene, poliglecaprone 25, macro- porous and partially absorbable mesh. Immediate post-operative period was uneventful. Last review at 7 months showed no complication. Clinical discussion: About 1 % of inguinal hernias retain part or whole appendix. In Amyand's hernia, 0.07-0.13 % of appendix is more prone to trauma, impaired vascular supply, inflammation, and microbial multiplication. Index patient's appendix was inflamed and histology confirmed focal acute transmural inflammation and denudation of appendiceal epithelial walls. Mesh repair is generally contraindicated in appendicitis or ruptured appendix but no post-operative complication occurred in index patient up to 7 months after appendectomy via the hernia with mesh repair. Conclusion: Amyand's hernia with acute appendicitis is rare. Though use of mesh during surgery is controversial, hernioplasty was done in index patient because of the predisposing history of a movement disorder and recurrence rate of herniorrhaphy.