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2018 ; 44
(ä): 8-10
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Amyand s hernia with acute gangrenous appendicitis and cecal perforation: A case
report and review of the literature
#MMPMID29455120
Kromka W
; Rau AS
; Fox CJ
Int J Surg Case Rep
2018[]; 44
(ä): 8-10
PMID29455120
show ga
INTRODUCTION: An Amyand's hernia is a heterogeneous clinical condition defined by
the presence of the vermiform appendix within an inguinal hernia sac, which may
or may not contain other abdominal contents or pathologic inflammatory changes.
Herein we present an exceptionally rare case of an Amyand's hernia containing
acute appendicitis and a perforated cecum. PRESENTATION OF CASE: A 46-year-old
male with a right inguinal hernia of 2-3?year duration presented to our Emergency
Department complaining of acute onset abdominal and groin pain. The patient was
diagnosed with an incarcerated right inguinal hernia and underwent emergent
surgical repair. Intraoperatively a reactive fluid was found within the hernia
sac that prompted an exploratory laparotomy for suspected bowel perforation. The
hernia was then found to contain an inflamed gangrenous appendix with an inflamed
and perforated cecum. An ileocecectomy and enteroenterostomy was performed and
the hernia defect was repaired without mesh. DISCUSSION: With an estimated
incidence of only 1%, Amyand's hernias are rare and lack a clear evidence-based
management scheme. Moreover, they can contain a diverse range of pathologic
features and presentations that can complicate diagnosis and treatment. To avoid
potential morbidity and mortality, the surgeon must consider an Amyand's hernia
on his or her differential when operating on inguinal hernias and be aware of the
associated presentations, complications, and management schemes. CONCLUSION:
There is a paucity of reports describing simultaneous appendicitis and cecal
perforation within an Amyand's hernia. In our case, ileocecectomy and Bassini
hernia repair with close follow-up led to a favorable outcome.