Chad Harris
A 76-year-old male patient presented to the emergency department with a tender right sided inguinal lump. The pain had been acutely worsening and the patient was now showing signs of sepsis. He was generally fit and well, with no medical history and a previous laparoscopic right inguinal hernia repair 1993 using mesh. On examination, he had a tender right non-reducible inguinal hernia with localised skin changes (erythema and raised temperature). He was taken to theatre for urgent repair of an incarcerated recurrent inguinal hernia, where an Amyand hernia with a perforated appendix and localised abscess formation within the hernia was found. First described in 1736 by Claudius Amyand, an Amyand hernia is an inguinal hernia which contains a vermiform appendix that can be with or without appendicitis. Inguinal hernias are one of the most common surgical problems with up to 27% of adult men developing one in their lifetime. However, Amyand hernias are very rare, making up only 1% of inguinal hernia cases. This case was complicated by an acute appendicitis which has an incidence of around 0.08-0.13%. Amyand hernias with appendicitis are very rare phenomenon and a lack of specific signs and symptoms, makes differentiating them from a strangulated inguinal hernia clinically impossible. CT and USS may provide a diagnosis prior to surgical repair but the vast majority are diagnosed intraoperatively.
