Perforated Amyand's hernia in a recurrent inguinal hernia

Abstract

Introduction: Amyand's hernia is an uncommon entity, which is characterized by the presence of the ileocecal appendix in an inguinal hernial sac. Case report: We present a case of a 72-year old male with a 10 cm mass in the right inguinal region showing cutaneous fi stulization with a central necrotic ulcer. Computerized tomography reveals a complicated Amyand's hernia with a perforated appendicitis and an adjacent 4 × 4 × 6 cm abscess. The patient underwent an open appendectomy with lavage and debridement of the subcutaneous tissue, and direct suture of the fascial components of the hernia defect. No prosthetic material was used due to the signifi cant local contamination. Discussion: Amyand's hernia was fi rst described by Claudius Amyand in 1735, when he diagnosed an acute appendix in a hernial sac. In 2008 Lossanoff and Basson described the fi rst classifi cation of this type of hernia based on the existence or not of an associated infl amed appendix and an abdominal extension of the infection. The surgical treatment depends on the intraoperative fi ndings that classify the type of hernia. Amyand's hernia is an uncommon entity, due to its low incidence and that it often presents with mild symptoms and ambiguous fi ndings on diagnostic imaging tests, representing in most cases a diagnostic challenge. Surgical treatment plays not only a therapeutic role, but also a diagnostic one.