Rare Case report of Amyand's Hernia in a Premature Infant

Although inguinal hernias are a common finding in premature infants, it is usually caused by the protrusion of the bowel through a persistent patent processus vaginalis. However, acute appendicitis in association with an inguinal hernia in this age group is a rare finding. This type of hernia is referred to as an Amyand hernia.

EP.FRI.103 Acute Appendicitis in an Amyand Hernia – a case report and literature review

Introduction An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73 year old male patient presented with a two day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x 10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy. Method We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970-2020. Results We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review. Conclusion Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intraoperative findings.

827 Acute Appendicitis in An Amyand Hernia – A Case Report and Literature Review

Introduction An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73-year-old male patient presented with a two-day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy. Method We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970 to 2020. Results We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review. Conclusions Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intra-operative findings.

Amyand Hernia in a Pediatric Patient With Acute Perforated Appendicitis Undergoing Laparoscopy: A Brief Report and Literature Review

An 8-year-old male presented for evaluation of symptoms consistent with appendicitis. Upon laparoscopy, the patient was found to have appendicitis with a concomitant Amyand hernia. The latter pathology highlights a rare presentation of inguinal hernias in which the vermiform appendix herniates into the inguinal canal. Inguinal hernias are frequently encountered in pediatric populations; however, Amyand hernias have seemingly negligible incidence in all age demographics. These comprise roughly 1% of all diagnosed abdominal hernias. When seen in concurrence with appendicitis, the incidence is 0.13%. Recent literature has sought to classify types of Amyand hernias and criteria described by Losanoff and Basson is an attempt to guide surgical management. Although our management did not coincide with the proposed management above, the patient made a full recovery. In conclusion, Amyand hernias remain a rare entity that can be indistinguishable from routine inguinal hernias on clinical examination and management of Amyand hernia with appendicitis is not well defined.