Indirect Amyand hernia with gangrenous appendicitis

Case contributed by Dr Yair Glick

Presentation

Abdominal pain for several days. "Periappendicular abscess" at abdominal US done in clinic. Referred to ED.

Patient Data

Age: 25 years
Gender: Male

Thickened appendix with caudal course. Its tip is 19 mm in thickness with tiny focus of fluid inside, located at entrance to deep inguinal ring (indirect hernia). No evidence of fat stranding.

Case Discussion

An inguinal hernia containing an appendix is termed an Amyand hernia after Sir Claudius Amyand, who performed the first successful appendectomy in 1735. It is very rare; an appendix is demonstrated in less than 1% of inguinal hernias. The appendix is inflamed in a small percentage of Amyand hernias.

This case demonstrates a thickened vermiform appendix with a seemingly bulbous tip, perhaps rolled on itself, stuck in an indirect inguinal hernia. No fat stranding is seen, nor is there a periappendicular abscess (as stated in the ultrasound report from the clinic).

At surgery, the surgeons struggled to extricate a gangrenous appendix from the hernia before they could resect it.

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Case Information

rID: 52439
Case created: 7th Apr 2017
Last edited: 21st Apr 2017
Inclusion in quiz mode: Included

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