Strangulated Hernia with Appendicitis: A Rare Case of Amyand’s Hernia in a 72-Year-Old Man

Abstract

Introduction: Amyand’s hernia is an extremely rare and atypical hernia that is difficult to diagnose clinically characterised by engagement of the appendix in the inguinal sac. The aim of this report is to describe a case of Amyand’s hernia in a 72-year-old man with a history of hypertension on well-controlled calcium channel blockers, and to highlight the importance of surgical exploration in the diagnosis and management of this condition. Case Report: We present a rare case of a 72-year-old man with a history of well-controlled calcium channel blocker hypertension presenting with intermittent right inguinal pain. The patient was admitted to the hospital’s surgical emergency department and was deemed in need of surgical exploration due to suspected strangulated hernia or irreducible hernial engorgement. Preoperative examination revealed no signs of appendicitis. During surgery, an Amyand’s hernia was discovered with an inflamed appendix. Intraoperative work-up was otherwise normal. Discussion: Amyand’s hernia is an extremely rare condition, accounting for less than 1% of all adult inguinal hernias. Acute appendicitis in the context of Amyand’s hernia is even rarer, accounting for only 0.1% of all cases of acute appendicitis. This hernia may remain asymptomatic until inflammation of the appendix leads to incarceration, strangulation, necrosis, perforation or rupture. Early symptoms include inguinal tenderness and swelling. CT scanning is essential for accurate and early diagnosis of Amyand’s hernia, which can help avoid the complications of delayed surgery. Conclusion: This case highlights the importance of early CT scanning for accurate diagnosis of Amyand’s hernia with appendicitis. Management of this rare condition requires appendectomy combined with repair of the hernia, depending on the degree of inflammation of the appendix and the anatomical features of the patient.