CLINICAL EVALUATION AND TREATMENT OF AMYAND HERNIA WITH SEVERE APPENDICITIS: A CASE REPORT

Abstract

Background: 

Amyand hernia is an uncommon clinical condition in which appendix coexists with an inguinal hernia sac. The condition can be challenging to diagnose and necessitates quick surgical action.

Case Presentation: 

We report the case of a 27-year-old man with a history of reducible bilateral inguinal hernias who presented to the emergency room after experiencing abdominal pain, fever, vomiting, and anorexia for four days. Physical examination revealed tenderness in the right lower quadrant and epigastric region, along with positive rebound tenderness and Rovsing's sign. Laboratory results showed leukocytosis, and an abdominal CT scan revealed complicated appendicitis within the right inguinal hernia sac, surrounded by a fluid collection.

Discussion:

The pathophysiology of Amyand hernia is not fully understood, and the exact cause of appendicitis in this context remains speculative, primarily attributed to microcirculatory ischemia and compression.

Management of Amyand hernia is controversial, with the most established framework being the Losanoff and Basson Classification. However, we discuss three critical issues that warrant reconsideration within this classification: the indications for appendectomy in type 1, the role of laparoscopic approaches in general, and the necessity for a laparotomy incision in type 3.

Conclusion: 

 The three points of disagreement highlight the need for a revised management protocol based on additional publications, such as this case report. This concern has also been echoed by Losanoff and Basson.