Amyand’s hernia — Always an operative surprise

Abstract

Acute appendicitis in an inguinal hernia is termed an Amyand’s hernia. This is an extremely rare condition that is often misdiagnosed. It may present as a tender inguinal or inguinoscrotal swelling. The clinical presentation varies depending on the extent of inflammation in the hernia sac and associated peritoneal contamination. The authors report a rare case of Amyand’s hernia in a 2-month-old boy who presented with features of a strangulated right inguinal hernia. The patient was successfully managed with strict adherence to the basic principles of resuscitation and stabilisation before surgery. Our aim is to highlight the rare presentation of a common disease and to review the relevant available literature. In paediatric patients with Amyand’s hernia, the type of hernia repair and the operative approach is determined mainly by the inflammatory status of the appendix. Incidental appendicectomy in the case of a normal appendix is not favoured. However, in cases of children with an inflamed or complicated appendix, treatment includes appendicectomy (via the hernia sac) and hernia repair. After reviewing the literature, authors emphasise the extreme rarity of the case, underlining the diagnostic dilemma it creates.