Anatomic and Surgical Considerations in Amyand's Hernia

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
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