HERNIA AMYAND - O ENTITATE ANATOMOCLINICÃ RARÃ DIAGNOSTICATÃ INTRAOPERATOR
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.
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