De Garengeot hernia: an analysis of our experience

Aim The presence of a vermiform appendix in a femoral hernia sac is termed De Garengeot hernia. It may present as a tender and/or erythematous groin swelling and is often misdiagnosed as an incarcerated or strangulated femoral hernia. The purpose of this study is to review the management of De Garengeot hernia at a single institution since 1991. Materials and methods A retrospective analysis of seven consecutive patients operated upon at our institution from 1991 to 2006 with De Garengeot hernia was undertaken. Patients’ demographics, treatment performed and postoperative outcome were analysed. Results There were three men and four women. The median age was 55 years. None of the patients were diagnosed preoperatively. The commonest presenting symptom was painful groin swelling. All patients therefore underwent emergency surgery with a presumptive diagnosis of either incarcerated or strangulated femoral hernia. Operative findings included four normal appendices, two inflamed appendices and one perforated appendix in the femoral hernial sac. Patients with normal appendix (n = 4) had mesh hernia repair without an appendicectomy. The rest of the patients (n = 3) with abnormal appendix underwent emergency open appendicectomy followed by sutured hernia repair. We had no deaths in this series and one minor wound infection. No recurrent hernia has been detected to date. Conclusion Inflammation of the appendix determines the type of hernia repair and surgical approach. Incidental appendicectomy in the case of a normal appendix is not preferred.     

Incarcerated Amyand’s hernia in a premature infant associated with circumcision: a case report and literature review

Amyand’s hernia is a rare presentation of an appendix within an inguinal hernia sac. It is commonly mistaken for an incarcerated or strangulated hernia. Prompt diagnosis requires awareness of this entity, as well as associated radiologic findings on computed tomography (CT) and ultrasound. Treatment includes antibiotics and surgical intervention involving appendectomy and hernia repair. We present a case of a premature infant who developed systemic symptoms after a circumcision and was eventually diagnosed with an Amyand’s hernia with concurrent appendicitis.     

Amyand’s hernia: a series of 30 cases in children

Amyand’s hernia is a very rare condition with a presence of a vermiform appendix in an inguinal hernia sac. It is estimated to be found in approximately 1% of adult inguinal hernia. In this study, we report a retrospective analysis of 30 patients aged between 19 days and 8 years with an Amyand’s hernia operated in our institution from 1998 to 2009, and we reviewed the literature on the topic. Hernia repair without an appendectomy was performed in patients with normal appendix. Emergency appendectomy through herniotomy was performed in cases of inflamed and perforated appendices.     

Perforated appendix and periappendicular abscess within an inguinal hernia

We report an extremely rare case of complicated Amyand’s hernia. A 61-year-old male patient was admitted with clinical signs of incarcerated right inguinal hernia and localised tenderness in the right iliac fossa. He underwent emergency surgery and the operative findings included perforated appendix and periappendicular abscess within a right inguinal hernia sac. Appendectomy and Shouldice’s herniorrhaphy without prosthetic mesh placement were performed. Histology revealed the presence of a villous adenoma near the base of the appendix. We point out that although Amyand’s hernia is a very rare clinical entity, it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia, especially when there are no pathological findings on the abdominal X-rays.     

Amyand’s hernia in premature neonates: report of two cases

The finding of a normal or inflamed vermiform appendix within an inguinal hernia is termed Amyand’s hernia. It is extremely rare in children, especially in infants and neonates. When it occurs, it is usually misdiagnosed as an irreducible or strangulated inguinal hernia, and the accurate diagnosis is made intraoperatively. We report two cases of Amyand’s hernia in premature neonates. Both patients presented on admission with signs and symptoms indicating a strangulated right inguinal hernia, and the accurate diagnosis was made intraoperatively. One of them had progressed to local peritonitis. Appendicectomy and hernia repair were made at the same time through an inguinal transverse incision, and the postoperative course was uneventful in both. We point out the need to consider acute appendicitis in the differential diagnosis of strangulated right inguinal hernia.     

Amyand’s hernia with adenocarcinoid tumor

The contents of an incarcerated inguinal hernia sac usually consist of small bowel or omentum. Amyand’s hernia, the situation in which appendicitis is noted in the hernia sac, is a rare occurrence. Also, neoplasms of the appendix is quite uncommon. The occurrence of these two conditions together is even more rarely reported. We report the case of a 62-year-old male with these two diseases simultaneously. Incarcerated inguinal hernia was noted before operation. Amyand’s hernia was noted during the operation. Adenocarcinoid tumor of the appendix was noted after the operation. Operative decisions were changed during the medical course.     

Incarcerated recurrent inguinal hernia with covered and perforated appendicitis and periappendicular abscess: case report and review of the literature

We report the case of a 72-year-old woman with a covered and perforated appendicitis and periappendicular abscess within the hernial sac (Amyand’s hernia) of an incarcerated recurrent inguinal hernia after primary Shouldice repair. Initially, a preoperative CT-scan showed signs of an incarcerated femoral hernia. This would be the first reported case of an incarcerated recurrent Amyand’s hernia, which is an extremely rare condition.     

Left sided Amyand’s hernia

The presence of the appendix in an inguinal hernia sac has been referred to as Amyand’s hernia. Vermiform appendix located in an external hernia sac is not an uncommon condition, and the incidence of these cases is approximately 1%. In Amyand’s hernias, appendices are frequently found in the hernia sac; but an incarceration particularly on the left side is a very unusual sight. In this report we present 32-year-old male with Amyand’s hernia on the left side.     

Amyand’s hernia — Always an operative surprise

Acute appendicitis in an inguinal hernia is termed an Amyand’s hernia. This is an extremely rare condition that is often misdiagnosed. It may present as a tender inguinal or inguinoscrotal swelling. The clinical presentation varies depending on the extent of inflammation in the hernia sac and associated peritoneal contamination. The authors report a rare case of Amyand’s hernia in a 2-month-old boy who presented with features of a strangulated right inguinal hernia. The patient was successfully managed with strict adherence to the basic principles of resuscitation and stabilisation before surgery. Our aim is to highlight the rare presentation of a common disease and to review the relevant available literature. In paediatric patients with Amyand’s hernia, the type of hernia repair and the operative approach is determined mainly by the inflammatory status of the appendix. Incidental appendicectomy in the case of a normal appendix is not favoured. However, in cases of children with an inflamed or complicated appendix, treatment includes appendicectomy (via the hernia sac) and hernia repair. After reviewing the literature, authors emphasise the extreme rarity of the case, underlining the diagnostic dilemma it creates.