Anatomic and Surgical Considerations in Amyand's Hernia

Hosp Aeronáut Cent 2012; 7(1): 14-15.
Anatomic and Surgical Considerations in Amyand’s Hernia
My. (E. Med.) Rubén D. Algieri (MAAC)*, María Soledad Ferrante (MAAC)**, 1er Ten. “e.c.” (E. Med.)
Benjamín Nowydwor***, 1er Ten. “e.c.” (E. Med.) Verónica D´Amore***, 1er Ten. “e.c.” (E. Med.) Félix
Viglione***, 1er Ten. “e.c.” (E. Med.) Alejandro Ciano***
General Surgery Service - Hospital Aeronáutico Central – Ventura de la Vega 3697 – Ciudad
Autónoma de Buenos Aires (C.A.B.A.)
* Head of the General Surgery Service, Hospital Aeronáutico Central.
** Surgeon of the General Surgery Service, Hospital Aeronáutico Central.
*** General Surgery Resident, Hospital Aeronáutico Central.
Received: January 18 th , 2012. Accepted: February, 15 th , 2012.
Introduction
Amyand’s hernia is characterized by the presence
of the cecal appendix as content of the inguinal
hernia, and it has low frequency (0.13% of the
cases)(7,8,10,11). It usually presents as a
complicated inguinal hernia. The acute
appendicitis diagnosis is generally obtained during
the intraoperative period. It has been named after
Claudio Amyand (surgeon of King George II), who
was the first to describe the presence of a
perforated appendix related to a fistula within the
inguinal hernial sac of an eleven-year-old child
of approximately 4x4 cm., is irreducible and grows
in size with the Valsalva maneuver.
An urgency surgical conduct is decided (photos 1
and 2), with presumptive diagnosis of obstructed
inguinal hernia. In the surgery, acute intraherniary
appendicitis is identified. An appendectomy and
anatomical inguinal hernioplasty are carried out.
The patient evolves favorably during the
postoperative period.
(1,5).
Objectives
Case presentation and literature reviewed.
Case Report
38-year-old, male patient who consults about a
painful tumor in the right inguinal region, and 4-
hours evolution sickness and vomits. The tumor,
Photo 1. Intraherniary cecal appendix.
14

Algieri et al, Hosp Aeronáut Cent 2012; 7(1): 14-15.
When the appendix is found to be normal, the
appendectomy is not recommended; only viscera
reduction and herniary sac treatment are
recommended. If acute appendicitis is found out,
appendectomy through the herniary sac is
suggested, in absence of infection within the
abdominal cavity (1,2,4,8,9,12) or exploratory
laparotomy to clean and place drainage after the
appendectomy through this surgical approach
(4,10,12).
Photo 2. Intraherniary cecal appendix.
Discussion
An hernia is the protrusion of viscera or part of
them through the abdominal wall. In the inguinal
region, the herniary sac may contain the omentum
or intestine. However, certain unusual content
may be found, such as the bladder, a Meckel’s
diverticulum (Littré’s hernia), or a portion of the
intestine circumference (Richter hernia).
Amyand’s hernia refers to the presence of the
appendix within the herniary sac (5,8,10). It is really
difficult to reach a clinical diagnosis of Amyand’s
hernia before the operation. The typical
characteristic of this type of hernia is pain in the
abdominal right lower quadrant, related to a
sensitive, tense and irreducible mass in the
inguinal region. However, with this clinical
presentation the diagnosis is easily mistaken for
that of a complicated inguinal hernia, being this
one the most important differential diagnosis.
Occasionally it is possible to recognize the typical
prodromal symptoms of an appendicitis such as
epigastric or periumbilical pain, that later migrate
towards the right iliac fossa and/or the inguinal
region (6,7,8,12). Therefore, the diagnosis is made
during the surgery while the patient is subjected to
surgical exploration due to a complicated inguinal
hernia (3,7,8,12).
References
1. Amyand C. Of an inguinal rupture, with a pin in the appendix
caeci incrusted with stone; and some observations on wounds
in the guts. Phil Trans R Soc Lond 1736;39:329-42.
2. Franko J, Raftopoulos I, Sulkowski R. A rare variation of
Amyand’s hernia. Am J Gastroenterol. 2002; 97(10):2684-5.
3. Greenberg J, Arnell TD. Diverticular abscess presenting as
an incarcerated inguinal hernia. Am Surg 2005; 71: 208-209.
4. Hiatt JR, Hiatt N. Amyand’s hernia. N Engl J Med 1988;
318(21):1402.
5. Hutchinson R. Amyand’s hernia. J R Soc Med 1993; 86:
104-105
6. Irvin T. Abdominal pain: a surgical audit of 1190emergency
admissions. British Journal of Surgery 1989;76: 1121-1125.
7. Lawrence I, Chad F. Acute appendicitis in a femoral hernia:
an unusual presentation of a groin mass. The Journal of
Emergency Medicine 2002; 23: 15-18.
8. Logan MT, Nottingham JM. Amyand’s hernia: a case report
of an incarcerated and perforated appendix within an inguinal
hernia and review of the literature. Am Surg. 2001;67(7):628-9.
9. Luch JS, Halpern D, Katz DS. Amyand’s hernia: prospective
CT diagnosis. J Comput Assist Tomogr 2000; 24:884-6.
10. Orr KB. Perforated appendix in an inguinal hernial sac:
Amyand’s hernia. Med J Aust 1993; 159: 762-763.
11. Osorio JK, Guzman-Valdivia G. Ipsilateral Amyand’s and
Richter’s hernia, complicated by necrosing fascitis. Hernia
2006; 10: 443-446.
12. Thomas WE, Vowles KD, Williamson RC. Appendicitis in
external hernias. Ann R Coll Surg Engl. 1982;64:121-2.
Hospital Aeronáutico Central 15