scholarly journals Case report: Amyand hernia reincarnate and the utility of computed tomography

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Joshua Fields ◽  
Kristen Quinn ◽  
Laura Hollinger ◽  
Richard Jones

Abstract Background An Amyand hernia is a rare condition in which the vermiform appendix follows the bowel as it bulges through the inguinal canal. Originally described by Claudius Amyand in 1735 in an 11-year-old boy who had a pin in the appendix (Philos Trans R Soc Lond. 1735;39:329–36), we describe here the first case with CT depicting all components of Dr. Amyand’s original case. Case presentation A 10-year-old boy presented with right lower quadrant and groin pain. CT imaging revealed a retained metallic foreign body perforating the appendix, acute appendicitis, and an Amyand hernia. A laparoscopic attempt at reduction failed due to tethering by the needle and inflammation of the hernia sac, requiring an open inguinal exploration and excision of the hernia sac. The patient was discharged on postoperative day 2 with plans for delayed hernia repair. Conclusions CT is a crucial diagnostic test for surgical decision-making in Amyand hernias. In this case, it accurately classified the hernia and led to anticipation of unsuccessful laparoscopic hernia reduction. Management in the setting of foreign body and perforation includes appendectomy and tissue herniorrhaphy with delayed formal inguinal hernia repair after inflammation has subsided.

2019 ◽  
Vol 2019 (5) ◽  
Author(s):  
Adam O’Connor ◽  
Peter Asaad

Abstract De Garengeot hernia is a rare subtype of femoral hernia whereby the vermiform appendix is located within the hernial sac. Even rarer is the presence of appendicitis within the hernia sac. De Garengeot’s hernia is difficult to diagnose pre-operatively and can prove technically difficult at operation particularly with regards to mobilization of the caecum and appendix in order to perform appendicectomy. Laparoscopic, open, with and without mesh repair of de Garengeot hernia have all been described in the literature with varying degrees of success. We present a case of an 82 year old lady presenting with an acutely painful right sided groin lump. CT scan revealed the presence of de Garengeot hernia with acute appendicitis. We describe in text and photo format our approach to the hernia repair, appendicectomy and provide a short review of the literature with regards to the different operative approaches to such a patient.


2019 ◽  
Vol 2019 (9) ◽  
Author(s):  
Ammar Omran ◽  
Bardisan Sleman Gawrieh ◽  
Aras Abdo ◽  
Mohammad Ali Deeb ◽  
Mohammad Almahmod Khalil ◽  
...  

Abstract The presence of vermiform appendix in an inguinal hernia sac is known as Amyand’s hernia. This research paper examines the case of a 28-day-old Syrian male presented with a history of an infected right-sided hydrocele from the age of 14 days. Upon admission, ultrasonography was reported as a right testicular torsion. Accordingly, emergency surgical exploration was performed, and by exposing the spermatic cord fascia, 7 mL of pus was drained, revealing the cecum and perforated appendix lying beside the right testis, which showed evidence of ischemia and bluish discoloration.


2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Emin Kose ◽  
Abdullah Sisik ◽  
Mustafa Hasbahceci

Amyand’s hernia is defined as protrusion of the vermiform appendix in an inguinal hernia sac. It is a rare entity with variable clinical presentation from normal vermiform appendix to abscess formation due to perforation of acute appendicitis. Although surgical treatment includes appendectomy and hernia repair, appendectomy in the absence of an inflamed appendix and use of a mesh in cases of appendectomy remain to be controversial. The aim of this study was to review the experience of mesh inguinal hernia repair plus appendectomy performed for Amyand’s hernia with noninflamed appendices. There were five male patients with a mean age of 42.4 ± 16.1 years in this retrospective study in which Amyand’s hernia was treated with mesh inguinal hernia repair plus appendectomy for noninflamed appendices. Patients with acute appendicitis and perforated vermiform appendix were excluded. There were four right sided and one bilateral inguinal hernia. Postoperative courses were uneventful. During the follow-up period (14.0 ± 7.7 months), there was no inguinal hernia recurrence. Mesh inguinal hernia repair with appendectomy can be performed for Amyand’s hernia in the absence of acute appendicitis. However, presence of fibrous connections between the vermiform appendix and the surrounding hernia sac may be regarded as a parameter to perform appendectomy.


2021 ◽  
Vol 5 (1) ◽  
pp. 803-805
Author(s):  
Dimitar Hadzhiev ◽  
Dzhevdet Chakarov ◽  
Evgeniy Moshekov ◽  
Boris Sakakushev ◽  
Elena Hadzhieva

Amyand hernia is a rare presentation in inguinal hernias (less than 1% of cases with inguinal hernias) which is evidenced when in herniated masses the presence of inflamed appendix is ​​ascertained or not. It was named after a French surgeon, Claudius Amyand (1660-1740), who performed the first successful appendectomy in 1735, where he found an acute appendicitis in a herniated mass. Most cases are diagnosed intraoperatively, as an accurate preoperative diagnosis rarely becomes evident. Management is individual depending on the stage of inflammation of the appendix, the presence of abdominal sepsis and concomitant factors. The decision should be based on factors such as the patient's age, the size and anatomopathological shape of the appendix, and in the case of an inflamed appendix, standard appendectomy and retinal herniorrhage should be the gold standard of treatment. Amyand hernia is usually misinterpreted as a common incarcerata hernia. Symptoms that mimic appendicitis may appear. Treatment consists of a combination of appendectomy and hernia repair. The inflammatory status of the appendix determines the type of hernia repair and the surgical technique. Occasional appendectomy in the case of a normal appendix is ​​not recommended. Amyand hernia is a rare type of inguinal hernia in which the appendix is located in the hernia sac. We present a case of a recurrent incarcerated Amyand’s hernia with complicated appendicitis. The 78 old polymorbide patient with right-sided incarcerated recurrent hernia was emergently operated on and appendectomy and non-mesh hernioplasty performed, on the 3rd postoperative day for a heart attack he was placed cardio stimulator with uneventful outcome. Fifteen months follow up did not show complications or complaints.


2021 ◽  
Vol 19 (3) ◽  
pp. 270-272
Author(s):  
Furkan Karahan ◽  
◽  
Arif Atay ◽  
Neşe Ekinci ◽  
Emine Özlem Gür ◽  
...  

Introduction. Appendix, located within the Spiegel hernia is a rare condition. Few cases have been reported to date. Although it is generally asymptomatic, patients can apply with strangulation findings. Along with the physical examination findings, imaging methods play an important role in diagnosis and definitive diagnosis is made intraoperatively. Per-operative surgical method is determined according to the condition of the structures in the hernia sac. If an appendix is detected in the hernia sac, appendectomy is often preferred regardless of symptoms. Postoperative pathology is mostly benign but malign appendix pathologies should be kept in mind. Aim. Here, we aimed to present our case undergoing emergency surgery due to incarcerated hernia as it is the first case of appendix neuroendocrine tumor in the Spiegel hernia sac according to our literature review. Description of the case. A 77-year-old female patient who was admitted to the hospital with complaints of nausea and vomiting was evaluated as an emergency. In the clinical evaluation of the patient, we detected ileus due to hernia. We operated on the patient and found the appendix and cecum in the spiegel hernia. We did appendectomy and hernia repair. Histopathological examination of the appendix revealed a well-differentiated neuroendocrine tumor. Conclusion. Detection of the appendix in a Spiegel hernia is a rare condition. This is the first case of appendiceal malignancy in a Spiegelian hernia.


Author(s):  
LEONARDO EMILIO DA-SILVA ◽  
RENATO MIRANDA DE MELO

ABSTRACT Incisional hernia is a late complication of the most frequent after abdominal surgeries, with resulting morbidity that can worsen the condition. The treatment has been done both by open techniques, using screens or not, and by laparoscopic and robotic methods, which use them systematically. However, introducing a permanent foreign body into the tissues requires more surgical time, despite not closing the parietal defect in most cases and a higher risk of infections. New technologies have been trying to improve these results, with absorbable prostheses (biological or synthetic), but their high cost and recurrences remain a severe problem. Even so, standard repair establishes reinforcement with screens, routine, and whether the approach is traditional or mini-invasive. The authors report their first case of endoscopic repair of incisional hernia, which occurred two years ago, with a Brazilian technique already fifty years old: the transposition with the hernia sac proposed by Prof. Alcino Lázaro da Silva in 1971.


2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Salvatore Fabio Chiarenza ◽  
Lorenzo Costa ◽  
Cosimo Bleve

In pediatric patients appendicitis is the most common cause of abdominal pain and surgery. Torsion of vermiform appendix is a rare cause, clinically indistinguishable from appendicitis with usually an intraoperative diagnosis. The first description of vermiform appendix torsion was made by Payne in 1918. Clinical presentation is similar to acute appendicitis. Preoperative investigations play a minimal role. Etiology of this condition is unclear, but is possible to distinguish a primary and a secondary torsion. We report a case of 5-years-old boy who presented with right lower quadrant abdominal pain. His clinical signs, symptoms and investigations mimicked an acute appendicitis. Intraoperatively we found a 720° appendix torsion on its base with its mesentery rotated in counter-clockwise direction. The appendix was gangrenous in appearance. A video-assisted trans-umbilical appendectomy was performed. We describe clinical presentation and management of this rare condition reviewing the literature.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuki Inagaki ◽  
Kohei Matsuo ◽  
Yoritaka Nakano ◽  
Tadashi Kondo

Abstract Background Acute colonic pseudo-obstruction (ACPO) is a rare condition observed in patients with some underlying medical or surgical conditions. To the best of our knowledge, this is the first case report of a patient with ACPO development and rapid septic progression after laparoscopic inguinal hernia repair. Case presentation A 78-year-old man who underwent transabdominal preperitoneal hernia repair (TAPP) for right inguinal hernia presented with difficulty in defecation and abdominal distension. He visited our emergency department on the third postoperative day. Enhanced computed tomography (CT) detected marked enlargement from the cecum to the rectum. There was no evidence of mechanical obstruction, ischemia, or perforation. He was diagnosed with postoperative constipation and received conservative management. He gradually started to improve; however, he suddenly experienced cardiopulmonary arrest 30 h after admission and could not be resuscitated. CT imaging of the abdomen during autopsy did not show any significant change, such as perforation, from the time of admission. Based on the clinical course and examination results, postoperative ACPO was considered the fundamental cause of fulminant obstructive colitis leading to sepsis. Conclusions ACPO following minimally invasive surgery is exceedingly rare. However, it is important to consider this disease as one of the differential diagnoses to avoid missing the chance for advanced therapy.


2013 ◽  
Vol 52 (189) ◽  
pp. 285-287 ◽  
Author(s):  
Ashis Pun ◽  
Roshan Khatri

The eponym ‘Amyand hernia’ coined in recognition of Claudius Amyand, the first surgeon to successfully perform appendectomy in a hernia sac containing appendix, refers to the vermiform appendix within inguinal hernia. Here, we present a rare case, of Amyand’s hernia in an 18 month-old boy who was brought with an inguino-scortal swelling which later on exploration was left sided Amyand’s hernia with sliding component. Amyand’s hernia is not very often seen in the clinical practice and its pre-operative diagnosis is very difficult hence awareness of this disease condition is essential for preoperative suspicion and even diagnosis of the condition. Keywords: Amyand’s hernia; acute appendicitis; hernial repair.


2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Jesse Cooper ◽  
Patrick Battaglia ◽  
Todd Reiter

Abstract Background Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. To the best of our knowledge, we present the first case of a patient with an iatrogenic hypercoaguable state performing self-neck manipulation, which resulted in a spinal epidural hematoma and subsequent quadriparesis. Case presentation A 63-year-old man presented to the emergency department with worsening interscapular pain radiating to his neck 1 day after performing self-manipulation of his cervical spine. He was found to be coagulopathic upon admission, secondary to chronic warfarin therapy for the management of atrial fibrillation. Approximately 48 h after the manipulation, the patient became acutely quadriparetic and hypotensive. Urgent magnetic resonance imaging revealed a multilevel spinal epidural hematoma from the lower cervical to thoracic spine. Conclusions Partial C7, complete T1 and T2, and partial T3 bilateral laminectomy was performed for evacuation of the spinal epidural hematoma. Following a 2-week course of acute inpatient rehabilitation, the patient returned to his baseline functional status. This case highlights the risks of self-manipulation of the neck and potentially other activities that significantly stretch or apply torque to the cervical spine. It also presents a clinical scenario in which practitioners of spinal manipulation therapy should be aware of patients undergoing anticoagulation therapy.


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