Presentation
Acutely painful swelling right groin, suspicious for incarcerated inguinal hernia. CT to confirm.
Patient Data
There is some fluid distension of the appendix, although the wall is not particularly thickened. The surrounding fat is inflamed, and most remarkably, the appendix lies within a right side indirect inguinal hernia, along with a substantial volume of fat. It is not clear whether this is primary appendicitis within a hernia sac, or whether the appendiceal changes are part of the hernia incarceration. The right inguinal region is larger than the left.
They underwent an open appendectomy and hernia repair.
PATHOLOGY
Macroscopic:
Normal looking appendix measuring 65 mm with discoloured mesoappendix
Microscopic:
Microscopy shows normal appendix tissue with no evidence of transmural active inflammation. There is no evidence of neoplasia and no parasites are seen.
Conclusion:
Appendix - normal
Case Discussion
An Amyand hernia is an inguinal hernia containing the appendix, whether it is primarily inflamed or not. Here there are mixed signs of appendicitis, with fluid distension but no wall thickening. There is periappendiceal fat stranding but that may have been due to incarceration of the fat around the appendix in the hernia sac. The pathology analysis confirmed that there was no acute appendicitis, so the imaging findings can be attributed to the incarceration of tissue within the hernia sac, including the appendix.
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