Meckel’s diverticulitis in Amyand’s hernia

Abstract

The presence of the appendix within an inguinal hernia has been referred to as ‘Amyand’s hernia’ to honour Cladius Amyand surgeon of King George II. Amyand was first to describe the presence of a perforated appendix within the inguinal hernial sac in 1735 [1]. Most cases are diagnosed intra-operatively rather than pre-operatively. Appendicular diverticulitis in an Amyand’s hernia was rare [2]. We present a case of an inguinal hernia containing both the Amyand’s hernia and a Meckel’s diverticulum. An 86-year-old man presented with a 20-year-old history of a bilateral inguinal mass. The mass in the right groin enlarged and became painful lately. The clinical examination of the abdomen was normal. There were swellingsin both groins, the right side being larger and tender, but the skin showed no signs of inflammation. The white blood cell count and the temperature were normal. Ultrasound examination described a hernia which contains mobile bowel segments inside, on the right side. The operation was performed by an anterior approach through an inguinal incision. A sliding hernia was found with the caecum comprising a hernial wall and the appendix protruding through the hernial sac being edematous and hyperemic (Fig. 1). An appendicectomy was done. Further exploration of the bowels revealed a Meckel’s diverticulitis which was managed by a wedge resection. We proceeded with the hernia repair and planted a mesh according to the Lichtenstein technique. Histopathologic examination showed a normal appendix vermiformix but revealed a Meckel’s diverticulitis. Post-operative recovery was uncomplicated; the patient was discharged 2 days after admission and had no complaints till now. The presence of the appendix within an inguinal sac is an uncommon condition and is referred to as ‘Amyand’s hernia’. The incidence of having a normal appendix within the hernial sac is 1 % [1, 3]. Most of the cases of Amyand’s hernia occur on the right side, probably as a consequence of the normal anatomical position of the appendix, and also because right-sided hernias are more Wiener klinische Wochenschrift The Central European Journal of Medicine Wien Klin Wochenschr (2012) 124:288–289 DOI 10.1007/s00508-012-0153-x