Amyand hernia: considerations for operative approach and surgical repair.

Abstract

The patient is presented to the emergency department following the acute onset of abdominal pain, nausea and a painful mass in the right groin. This was following several months of experiencing a painless bulge in the groin that appeared only with heavy lifting or straining. Physical exam exam revealed normal vital signs, a diffusely tender abdomen and an irreducible, exquisitely tender 5 cm firm mass in the right inguinal crease. The white cell count was 15.7×109/ L and CT abdomen and pelvis with intravenous contrast showed an indirect right inguinal hernia containing a dilated appendix measuring 11 mm with wall enhancement, a 5 mm appendicolith and surrounding fat stranding (figure 1). Based on the physician exam, clinical presentation and imaging, the patient was diagnosed with incarcerated right indirect hernia containing an acutely inflamed appendix without rupture. This was consistent with an amyand hernia. Figure 1 CT abdomen pelvis showing the appendix within an indirect right inguinal hernia. The appendix measures up to 11 mm with wall enhancement, and there is a 5 mm appendicolith. There is mild fat …