HERNIA AMYAND - O ENTITATE ANATOMOCLINICÃ RARÃ DIAGNOSTICATÃ INTRAOPERATOR

  • F. GRECU Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași
  • B. FILIP Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași
  • I. MOTOC Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași
  • Nadia ANDRIESCU Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași
  • A. LAPUSNEANU Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași
  • Manuela URSARU Spitalul Clinic Județean de Urgențe ”Sf. Spiridon” Iași
Keywords: INGUINAL HERNIA, ACUTE APENDICITIS, AMYAND HERNIA

Abstract

The Amyand hernia is an uncommon variant of the inguinal
hernia, rarely recognised before the surgical treatment because of the confusion with a strangled
hernia. In spite of this, the clinical presentation seems to follow a well determined pathway, so
it is possible to state that the uncorrect diagnosis is to be attributed to the ignorance of this
variant of hernia. We present two consecutive case reports of acute appendicitis founded in an
inguinal hernia sac. The clinical presentation depended on the inflammation extension inside the
hernia sac and the presence or not of peritoneal contamination. The patients were admitted for
a painful pseudotumor in the inguinal region with irreducibility, mimicking strangled inguinal
hernia with acute inflammatory syndrome. Intraoperatively we have found a hernia sac with a
phlegmonous/gangrenous appendix inside. Appendectomy was performed, followed by hernioplasty
(retrofunicular technique) without prosthetic material). The operation followings were
favorable. We conclude that amyand hernia must be considered as differential diagnosis of
apparently strangled inguinal hernias. Technical precautions and antibioprophylaxy applied
during surgery may prevent septic complications after hernioplasty. The hernia repair must be
performed without prosthetic material and using exclusively resorbable sutures.

Author Biographies

F. GRECU, Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași

Facultatea de Medicinã
Clinica a III-a Chirurgie

B. FILIP, Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași

Facultatea de Medicinã
Clinica a III-a Chirurgie

I. MOTOC, Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași

Facultatea de Medicinã
Clinica a III-a Chirurgie

Nadia ANDRIESCU, Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași

Facultatea de Medicinã
Clinica a III-a Chirurgie

A. LAPUSNEANU, Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași

Facultatea de Medicinã
Clinica a III-a Chirurgie

Manuela URSARU, Spitalul Clinic Județean de Urgențe ”Sf. Spiridon” Iași

Serviciul de Radiologie

References

1. Hutchinson R. Amyand’s hernia. J Royal Soc Med 1993; 86(2): 104-106.
2. Amyand C. Of an inguinal rupture, with a pin in the appendix coeci, incrusted with stone; and
some observations on wounds in the guts. Phil Trans Royal Soc 1736; 39: 329.
3. D’Alia C, Lo Schiavo MG, Tonante A et al. Amyand’s hernia: case report and review of the
literature. Hernia 2003; 7: 89-91.
4. Ryan WJ: Hernia of the vermiform appendix. Ann Surg 1937; 106: 135-139.
5. Breitenstein S, Eisenbach C, Wille G, Decurtins M. Incarcerated vermiform appendix in a
left-sided inguinal hernia. Hernia 2005; 9 (1): 100-102.
6. Lyass S, Kim A, Bauer J. Perforated appendicitis within an inguinal hernia: case report and review
of the literature. Am J Gastroenterol 1997; 92 (4): 700-702.
7. Doyle GS, McCowan C. Amyand hernia: a case of an unusual inguinal hernia. Am J Emerg Med
2008; 26 (5): 637.e5-6.
8. Losanoff JE, Basson MD. Amyand hernia: what lies beneath—a proposed classification scheme
to determine management. Am Surg 2007; 73 (12): 1288-1290.
9. Hiatt JR, Hiatt N. Amyand’s hernia. N Engl J Med 1988; 318 (21): 1402-1403.
10. Weber RV, Hunt ZC, Kral JG. Amyand’s hernia: Etiologic and therapeutic implications of two
complications. Surg Rounds 1999; 22: 552-556.
11. Lippolis PV, Barlettai M, Filidei F, Seccia M. The Aymand’s hernia. Case report and review of the
literature. Ann Ital Chir 2007; 78 (2): 153-157; discussion 157-158.
12. Sharma H, Gupta A, Shekhawat NS, Memon B, Memon MA. Amyand’s hernia: a report of 18
consecutive patients over a 15-year period. Hernia 2007; 11 (1): 31-35.
13. Kueper MA, Kirschniak A, Ladurner R, Granderath FA, Konigsrainer A. Incarcerated recurrent
inguinal hernia with covered and perforated appendicitis and periappendicular abscess: case report
and review of the literature. Hernia 2007; 11 (2): 189-191.
14. Nigri G, Costa G, Valabrega S et al. A rare presentation of Amyand’s hernia. Case report and
review of the literature. Minerva Chir 2008; 63 (2): 169-174.
Published
2019-11-04