Amyand's hernia with mucinous cystadenoma of the appendix

Abstract

Introduction: Amyand hernia is the appearance of the appendix inside the hernia sac in an inguinal hernia and its incidence is less than 1 % of all hernioplasties. The appendicular mucocele is a condition that occurs in less than 0.5 % of cases of acute appendicitis. There are very few cases reported in the literature associating these two rare entities. Case report: 84-year-old male patient with a history of COPD. During scheduled surgery of right inguinal hernia is observed an indirect hernia that contained cecal appendix with an inflammatory aspect (fig. 1) so we did appendectomy (fig. 2) and repair by Lichestein hernioplasty, assuming low probability of infection. Good recovery without incident. Pathological findings confirmed the presence of low-grade neoplasia, mucinous cystadenoma. Abdominopelvic CT not showed systemic disease so we decided expectant attitude. Discussion: Amyand's hernia may remain asymptomatic and behave like a normal inguinal hernia or can simulate strangulated hernia when the hernia contains inflamed appendix. In patients with clinical signs of incarcerated inguinal hernia, with locally inflammatory signs, but without signs of intestinal obstruction Amyand's hernia appendicitis in differential diagnosis must be considered Treatment includes hernioplasty with or without appendectomy and/or mesh repair depending on the vermiform appendix's inflammation status, the patient's general condition, and other factors. Amyand's hernia generally has a good prognosis, although serious complications have been described. Conclussion: We don't have a protocolized treatment for an infrequent pathology like Amyand's hernia. The appendix inflammation, contamination status, the age and comorbidities of the patient, as well as the surgical findings will determine the therapeutic attitude.