An unusual case of the Amyand hernia with perforated appendicitis and a sessile serrated lesion within a recurrent inguinal hernia

Abstract

The Amyand hernia is a rare type of inguinal hernia where the appendix is located within the hernial sac. It is present in less than 1% of inguinal hernias and in 0.13% of cases, it is associated with complications including acute appendicitis and perforation. This case details an 81-year-old female with recurrent Amyand hernia with perforated appendicitis and a sessile serrated lesion. A literature review was conducted to identify existing cases of the Amyand hernia and neoplasm or recurrent inguinal hernia. Fifteen cases of neoplastic appendix within an Amyand hernia were identified in the literature. All cases found acute appendicitis, three of which were perforated. Histology varied from adenocarcinoma, goblet cell, carcinoid, fibroma, and mucinous cystadenoma. There were nine identified cases of Amyand hernia within a recurrent inguinal hernia. Seven of these cases had acute appendicitis, three of which were perforated, whilst one was gangrenous. All cases performed an appendicectomy, and various open techniques were used for hernia repair with or without mesh. The most interesting finding of the literature review was that Amyand hernia is rarely diagnosed pre-operatively, and that there was a high incidence of appendicitis when in the presence of a neoplastic appendix or a recurrent inguinal hernia. This paper highlights the first reported case of an Amyand hernia with a simultaneous neoplasm and recurrent inguinal hernia, which was managed using a laparoscopic approach without hernia repair.