Indirect Amyand hernia with gangrenous appendicitis
Abdominal pain for several days. "Periappendicular abscess" at abdominal US done in clinic. Referred to ED.
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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.