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      A rare case of Amyand's hernia with acute appendicitis in a 69-year-old woman: a case report

      case-report
       
      Iberoamerican Journal of Medicine
      Hospital San Pedro
      Amyand's hernia, Inguinal hernia, Appendix, Hernia sac, CT, Appendectomy

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          Abstract

          Abstract Introduction: Amyand's hernia is an extremely rare and atypical hernia that is difficult to diagnose clinically characterized by the herniation of the appendix into the inguinal sac. The aim of this report is to describe a case of Amyand's hernia and highlights the importance of early CT scanning in reaching the exact and early diagnosis of Amyand's hernia. Case report: We present a rare case of a 69-year-old female patient with a history of intermittent pain in the right inguinal region is see at the emergency surgical clinic. The patient underwent a CT scan of the abdomen and a small pelvis, and an inflamed appendix was diagnosed. The inflamed appendix is herniated in the inguinal hernia sac. Computed tomography was the only modality to diagnose the hernia sac contents preoperatively. Discussion: The reported incidence of Amyand's hernia is less than 1% of all adult inguinal hernia cases. Acute appendicitis in Amyand's hernia is even less common, with 0,1% of all cases of acute appendicitis. This hernia may be present without symptoms until the inflammation of the appendix may lead to incarceration, strangulation, necrosis, perforation, or rupture. Early symptoms include tenderness and inguinal swelling. Conclusions: Computer tomography helps make an accurate and timely diagnosis of Amyand's hernia, thus avoiding complications from delayed surgery.

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          Most cited references19

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          Amyand's hernia: a report of 18 consecutive patients over a 15-year period.

          The presence of a vermiform appendix in an inguinal hernia sac is termed Amyand's hernia. It may present as a tender inguinal or inguino-scrotal swelling and is often misdiagnosed as an incarcerated or strangulated hernia. The purpose of this study was to review the management of Amyand's hernia at a single institution since 1991. A retrospective analysis was undertaken of 18 consecutive patients with an Amyand's hernia operated upon at our institution from 1991 to 2005. Patients' demographics, treatment and postoperative outcome were analysed. There were 17 men and one woman. Their median age was 42 years. None of the patients was diagnosed preoperatively. The commonest presenting symptom was painful inguinal or inguino-scrotal swelling (83%). All patients, therefore, underwent emergency surgery with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 11 normal appendices, four inflamed appendices and three perforated appendices in the inguinal hernial sac. Patients with a normal appendix (n = 11) had a mesh hernia repair without an appendicectomy. The rest of the patients (n = 7) with an abnormal appendix underwent emergency open appendicectomy followed by Bassini's sutured hernia repair. One patient died in the postoperative period of pneumonia. Only one recurrent hernia has been detected, with a median follow-up time of 6.4 years. The inflammatory status of the appendix determines the type of hernia repair and the surgical approach. Incidental appendicectomy in the case of a normal appendix is not favoured.
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            Amyand's hernia: a review.

            The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. The aim of this systematic review was to gather information concerning its prevalence, clinical image, diagnosis, and treatment. The MEDLINE database was thoroughly searched using the keyword "Amyand's hernia." Additional articles were gathered and evaluated. The true prevalence of Amyand's hernia seems lower than classically described. Its usual clinical image is identical to that of an incarcerated hernia, and thus it is almost impossible to diagnose preoperatively, although ultrasound and computed tomography can help. 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. Surgeons should be prepared if they encounter Amyand's hernia because appropriate treatment ensures hernia repair without complications and with avoidance of recurrence. Copyright © 2014 Elsevier Inc. All rights reserved.
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              Amyand’s hernia: A review

              Amyand’s hernia is defined as when the appendix is trapped within an inguinal hernia. While the incidence of this type of hernia is rare, the appendix may become incarcerated within Amyand’s hernia and lead to further complications such as strangulation and perforation. Incarceration of the appendix most commonly occurs within inguinal and femoral hernias, but may arise to a lesser extent in incisional and umbilical hernias. Incarcerated appendix has been reported in a variety of ventral abdominal and inguinal locations, yet its indistinct clinical presentation represents a diagnostic challenge. This paper reviews the literature on incarceration of the appendix within inguinal hernias and discusses current approaches to diagnosis and treatment of Amyand’s hernia and complications that may arise from incarceration of the appendix within the hernia.
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                Author and article information

                Journal
                ijm
                Iberoamerican Journal of Medicine
                Iberoam J Med
                Hospital San Pedro (Logroño, La Rioja, Spain )
                2695-5075
                2695-5075
                2020
                : 2
                : 4
                : 385-387
                Affiliations
                [1] Skopje orgnameUniversity Clinic of Surgery "St. Naum Ohridski" bul. 11 Oktomvri br. 53 orgdiv1Department of Radiology Macedonia del Norte
                Article
                S2695-50752020000400021 S2695-5075(20)00200400021
                10.53986/ibjm.2020.0065
                732731ca-b482-4c27-893d-64c51f116918

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 09 June 2020
                : 19 June 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 3
                Product

                SciELO Spain

                Categories
                Case Report

                Inguinal hernia,CT,Hernia sac,Appendix,Amyand's hernia,Appendectomy

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