Amyand’s hernia: a report of 18 consecutive patients over a 15-year period |
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Authors: | H Sharma A Gupta N S Shekhawat B Memon M A Memon |
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Institution: | (1) Department of Surgery, Whiston Hospital, Prescot, Merseyside, UK;(2) Department of General Surgery, Sawai Man Singh Medical College, Jaipur, India;(3) Astley House, Whitehall Road, Darwen, Lancashire, BB3 2LH, UK |
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Abstract: | Aim The presence of a vermiform appendix in an inguinal hernia sac is termed Amyand’s hernia. It may present as a tender inguinal
or inguino-scrotal swelling and is often misdiagnosed as an incarcerated or strangulated hernia. The purpose of this study
was to review the management of Amyand’s hernia at a single institution since 1991.
Material and methods A retrospective analysis was undertaken of 18 consecutive patients with an Amyand’s hernia operated upon at our institution
from 1991 to 2005. Patients’ demographics, treatment and postoperative outcome were analysed.
Results There were 17 men and one woman. Their median age was 42 years. None of the patients was diagnosed preoperatively. The commonest
presenting symptom was painful inguinal or inguino-scrotal swelling (83%). All patients, therefore, underwent emergency surgery
with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 11 normal
appendices, four inflamed appendices and three perforated appendices in the inguinal hernial sac. Patients with a normal appendix
(n = 11) had a mesh hernia repair without an appendicectomy. The rest of the patients (n = 7) with an abnormal appendix underwent emergency open appendicectomy followed by Bassini’s sutured hernia repair. One patient
died in the postoperative period of pneumonia. Only one recurrent hernia has been detected, with a median follow-up time of
6.4 years.
Conclusion The inflammatory status of the appendix determines the type of hernia repair and the surgical approach. Incidental appendicectomy
in the case of a normal appendix is not favoured. |
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Keywords: | Hernia Appendicitis Appendicectomy |
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