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Introduction:
Amyand hernia (AH) is a rare type of hernia characterized by the presence of appendix vermiformis in the inguinal hernial sac. It is rarely reported in women.
Presentation of case:
We presented a case of a 60- year old woman who was admitted initially with an abdominal wall abscess and found to have perforated appendix in the right...
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Background: Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal w...
Citations
... Despite the fact that AH is recorded in all age groups [1], it is diagnosed three times more often in childhood, when it is associated with patency of the vaginal process and, therefore, more often indirect [25,26]. Most cases of AH have been registered in premature newborns and young children [20]. ...
... The indirect course of the hernia makes it possible to communicate with the inguinal canal and scrotal cavities. That explains many cases of abdominal wall abscesses or scrotal pyocele (scrotal abscess) [23,26,[37][38][39][40], scrotal [41] or right groin entero-cutaneous fistula [42], pneumohernios due to the rupture of the caecum [43]. Cases with varying degrees of septic lesions of the spermatic cord and testis have also been published, ranging from ischemic inflammation [34] to necrosis followed by removal of the structures [44,45]. ...
... Primary hernia repair was performed in the most of published cases and case series [6,14,19,20,23,34,37,[54][55][56][57], (Table 1). Delayed operations due to septic complications of AH were less common than in adults [65] and were the exception rather than the rule in advanced purulent processes only [23,26,[37][38][39][40][41]43]. Appendicitis was not considered an obstacle to the ligation of processus vaginalis in most cases (Table 1). ...
Abstract
Introduction Amyand hernia (AH) is a rare disease, so there are no standard strategies and there are many different
aspects at each stage of its management. Based on our own experience, we encountered these differences even
in a small number of cases and therefore sought to review the literature to highlight the diversity of approaches
to this pathology. This review of the literature was not intended to describe the statistical findings found in the clinical
case series, but rather to highlight the clinical and surgical difficulties of AH in children. Nevertheless, we conducted
an introductory statistical study based on data from PubMed and Google Scholar to understand the global prevalence
of AH.
Materials and methods The search for the key terms Amyand hernia, Amyand’s hernia, and “children” between 2003
and 2023 resulted in 52 PubMed and 548 Google Scholar articles.
Results After the exclusion of irrelevant studies, 101 articles were found. A total of 83 case reports describing 182
pediatric patients were used to understand the demographic distribution of this pathology. Given the impossibility
of further comprehensive statistical analysis (due to heterogeneous data), a narrative design was used to describe
the remaining aspects of AH management. Finally, three clinical cases demonstrated the mentioned aspects.
Discussion As a result of the search, conclusions were drawn about the main difficulties in the management of AH
in children, which were discussed.
Keywords Amyand hernia, Appendicitis, Children, Malrotation, Appendectomy, Inguinal hernia repair
... Furthermore, a case of an Amyand hernia, where the appendix ruptured in the inguinal hernia sac, was also reported in another case and was initially diagnosed as an abdominal wall abscess. [11] Due to the usually atypical presentation in elderly patients, the diagnosis of acute appendicitis is particularly challenging in this age group. A variety of physiological changes in the elderly such as lower baseline body temperature, attenuated response to pyrogens, and compromised T-cell response may alter patient inflammatory response in the setting of acute appendicitis. ...
Acute appendicitis is associated with a relatively high mortality rate among elderly patients due to the unusual clinical presentation that often leads to misdiagnosis and, in turn, severe complications.
This report describes an extremely uncommon clinical manifestation of acute appendicitis in an elderly patient - a subcutaneous abdominal wall abscess initially treated as cellulitis. Despite the initial misdiagnosis, contrast-enhanced computed tomography revealed a circumscribed inflammatory process of the appendix that was in close proximity to the abdominal wall. The patient underwent a surgical drainage of the abscess, received broad-spectrum antibiotics, and was discharged on day 12 following an uneventful course.
Diagnosis of acute appendicitis in elderly patients is challenging due to the atypical clinical presentation and co-existing comorbidities that can be misleading. Early application of high-resolution imaging techniques is necessary to identify the cause of acute abdomen in the elderly population.
... Perforation associated with an Amyand hernia has been documented in the literature (5), as well as an abdominal wall abscess leading to an enterocutaneous fistula (6)(7)(8)(9). On rare occasions, these infections have caused necrotizing fasciitis of the abdominal wall musculature (10)(11)(12)(13)(14). ...
Acute appendicitis, while exceedingly common carries a wide range of clinically variable
presentations. We present a case of a perforated appendicitis manifesting clinically as an anterior abdominal
wall abscess and its subsequent management. There have been eight documented case reports to date of
direct extension into the anterior abdominal wall, in contrast to the commonly documented retroperitoneal
perforation. The management of this condition has varied in the published reports from intravenous
antibiotics to surgical debridement of the abdominal wall. The aetiology of the direct extension into the
abdominal wall remains nebulous. In our patient it was felt that the appendicolith could be a contributing
factor for perforation through the abdominal wall. Our patient was initially managed with intravenous
antibiotics and percutaneous abscess drainage, followed by an interval laparoscopic appendectomy three
weeks later. The patient’s age and her dementia precluded conservative management of the appendix post
percutaneous abscess drainage, as an elective appendectomy is no longer the standard of care. A colonoscopy
performed three months later also excluded a colonic malignancy. We believe this is the first documented
case of an abdominal wall pneumatocele which formed as part of the abdominal wall abscess. It is our
fervent desire that this case report contributes to the surgical armamentarium of acute care surgeons in the
management of this complex condition
... As regard the study of Savatmongkorngul et al. (2017), the majority of patients with BAT presented with tachycardia (56%) and systolic blood pressure below 90 mmHg. The increase in pulse rate, respiratory rate with normal blood pressure in patients with intraabdominal injuries in the current study can be explained by the presence of intra-abdominal hemorrhage as detected by CT in addition to sympathetic stimulation as a result of pain (El Menyar, 2017). ...
... La hernia de Amyand es una entidad rara, se caracteriza por la presencia del apéndice cecal dentro del saco herniario inguinal. [1,2] Se presenta el caso de un paciente masculino de 70 años de edad, con hernias inguinoescrotales bilaterales, la izquierda contenía apéndice cecal. Palabras clave: Hernia inguinal, apendicectomía. ...
... Amyand's hernia is a rare entity characterized by the presence of cecal appendix´s within the inguinal hernial sac. [1,2] The case of a 70-year-old male patient is presented. He had bilateral inguinoscrotal hernias, the left containing the ileocecal appendix. ...
... La hernia de Amyand es una entidad rara, se caracteriza por la presencia del apéndice cecal dentro del saco herniario inguinal. [1,2] Ocurre en el 1% de todas las hernias inguinales y el apéndice presenta complicaciones en el 0.1% de casos. [3,4,5] El diagnóstico pre operatorio es muy difícil y en la mayoría de los casos es incidental. ...
La hernia de Amyand es una entidad rara, se caracteriza por la presencia del apéndice cecal dentro del saco herniario inguinal.[1,2] Se presenta el caso de un paciente masculino de 70 años de edad, con hernias inguinoescrotales bilaterales, la izquierda contenía apéndice cecal.
... Irrespective of the side in which AH occurs, its clinical presentation ranges from a painless groin lump to an irreducible groin swelling, closely mimicking an incarcerated hernia [1, 2], a finding present in 76.8% of patients of our pooled cohort. More extreme forms may present with fasciitis of the right groin [11,34], scrotal and flank abscesses [35,36], or even with an enterocutaneous fistula [37]. Our data indicate that a vast majority of patients (74.5%) presented to an emergency department with a condition requiring prompt surgical intervention. ...
... The complication rate percentage should be interpreted with caution given the high likelihood of publication bias, especially in regard to mesh infectious complications, which were strikingly absent in the included studies. Ten total cases of wound-related complications were identified, comprising 6.6% of the entire patient pool, while none of these patients underwent mesh repairs during the initial surgery [1, 11,35,[45][46][47][48]. These data appear to be on par with reports on surgical site infection rates after groin hernia repair in the general population [49]. ...
Purpose:
To identify and sum all available evidence pertaining to the management of Amyand's hernia (AH).
Methods:
A systematic search of the MedLine, Scopus, and Google Scholar databases was performed for studies published until January 2020.
Results:
In total, 111 studies incorporating 161 patients were identified, 96 (86.4%) being case reports, 11 (9.9%) case series, and 4 (3.7%) retrospective patient cohorts. Mean patient age was 58.5 ± 19.6 years with 136 (83.9%) being males and 25 (16.1%) females. Furthermore, 149 (92.5%) cases were right-sided hernias while 12 (7.5%) cases were left-sided. Overall, 62.3% of patients presented emergently and 77.3% of patients' cohort were eventually diagnosed with incarcerated AH. Preoperative diagnosis of AH was established in 23.1% of patients and was achieved either by ultrasound (25%) or CT scan (75%). Operative findings consisted of normal appendix in 73 (45.4%) cases, uncomplicated appendicitis in 62 (38.5%) patients, and perforated appendix in 26 (16.1%). Regarding patients with appendicitis, mesh placement was reported for 17 (21.2%), herniorrhaphy was performed for 51 (63.7%) while 12 (15.1%) patients did not undergo hernia repair during the initial operation. Mesh utilization rates were significantly higher in patients with a normal appendix. Seven cases involved AH containing appendiceal neoplasms. Thirteen cases (8.6%) of postoperative complications were documented and a single case of postoperative death.
Conclusion:
AH is a rare type of inguinal hernia usually complicated by appendicitis. Hernia reconstruction should be tailored to each patient individually according to the extent of inguinal canal inflammation.
... Few cases of abdominal wall cellulitis were reported [1][2][3]. The first one, written by Yamaguchi et al., concerning a neurologically disabled patient, did not report the surgical technique but emphasized the importance of being aware of such cases and cautious with patients suffering from communication troubles. ...
We discuss here the case of a unique case of a complicated Spigelian hernia with incarcerated appendicitis presenting with a local cellulitis in the general emergency unit of a French hospital. Here, a local approach was performed and the appendicitis was operated on the site of the observed cellulitis, allowing the surgeon to take care of both the cellulitis, appendicitis and hernia.
A 57-year-old obese, diabetic woman, presented with 1 day history of purulent umbilical discharge. She was vitally stable and afebrile. Abdominal examination revealed a full abdomen with purulent discharge from the umbilicus, swelling with erythema and induration surrounding the umbilicus. Lab tests were normal. Initial impression was abdominal wall abscess. Ultrasound showed subcutaneous fluid collection. Non-contrast CT showed collection and abdominal wall defect at the umbilicus. On exploration of the abscess cavity, there were two defects (umbilical and supraumbilical) with appendix protruding through the umbilical defect and a part of a small bowel and omentum adherent to the other defect. Wash was given, bowel and omentum were released and appendectomy was performed. Histopathology showed mucinous cystadenoma with periappendicitis. We would like to highlight the rare occurrence of an appendiceal mucinous cystadenoma in such a clinical presentation.
Introduction
Inguinal hernia may contain vermiform appendix in very rare cases. This particular condition is known as Amyand’s hernia and it has an incidence of 1%. Diagnosis is very difficult preoperatively, so it is usually an incidental finding.
Presentation of case
We report a case of a 80 year old man with an irreducible mass in right inguinal region. During surgical procedure an Amyand’s hernia was identified and we performed hernioplasty sec Trabucco and appendectomy.
Discussion
According to Losanoff and Basson classification, our case was type 1 and its management is very controversial.
Conclusion
Surgical treatment depends on surgeon’s experience and on clinical evaluation because there are many factors that may increase morbidity and mortality.
