Neuroendocrine tumor of the appendix inside an incarcerated Amyand’s hernia

Amyand’s hernia is a rare type of hernia where the vermiform appendix is within an inguinal hernia sac. Tumors of the appendix are quite uncommon. The coincidence of an Amyand’s hernia with neuroendocrine tumor of the appendix, as in our case, is even more rarely reported.We report the case of an 81-year-old male who presented with an incarcerated right inguinal hernia. After resuscitation, the clinical diagnosis was confirmed by computed tomography. It showed an incarcerated right inguinal hernia which contained the distal ileum, cecum, thickened appendix, as well as a small amount of fluid. Subsequently, the patient was prepared for emergency surgery. During the operation, the hernia sac was found and opened. The appendix was swollen. Therefore, appendectomy was performed. The inguinal defect was repaired using the Modified Bassini Technique. The patient had an uneventful postoperative recovery and surprisingly the histopathology of the appendix revealed a 1.5 cm well-differentiated low grade neuroendocrine tumor (carcinoid) of the appendix tip.An incidental finding of neuroendocrine tumor of the appendix in a patient with s hernia is extremely rare. A high index of suspicion is the key to diagnose such a coincidence in order to safely and optimally treat such a condition.     

Incarcerated amyand hernia

Amyand’s hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated inguinal hernia generally masks the symptoms and signs of acute appendicitis, which renders preoperative diagnosis difficult. In this study, we present two cases of Amyand’s hernia that were diagnosed preoperatively. The patients were taken for operation with the prediagnosis of ?ncarcerated inguinal hernia. We evaluated these cases along with data from prior studies.     

A case report of incarcerated inguinal hernia: Amyand’s hernia with adenocarcinoma tumor

IntroductionInguinal hernia is one of the most common surgical problems, often posing technical challenges even to expert surgeons. Amyand’s hernia (AH) is an inguinal hernia whose sac contains the vermiform appendix. Primary appendiceal neoplasms are rare. We report the case of an appendiceal adenocarcinoma within an Amyand’s hernia, presenting as an incarcerated right inguinal hernia.Presentation of caseA 87-year-old male presented in the emergency department due to a persistent right inguinal pain. Clinical examination revealed a tender right groin mass. Under the diagnosis of an right inguinal hernia, an operation was taken. Intraoperatively, an inflamed appendix and a part of the cecum were found in the hernia sac. The operation was completed with an ileocecal resection and a modified Bassini hernia repair. Histological examination revealed a adenocarcinoma of the appendix.DiscussionAmyand’s hernia is an inguinal hernia that contains vermiform appendix in its sac. It consists 1% of all inguinal hernias while appendicitis in an Amyand’s hernia accounts for 0.1% of all appendicitis cases. Adenocarcinomas of the appendix are even rarer, accounting for 0.2% to 0.5% of all intestinal malignancies, and 4%–6% of primary appendiceal neoplasms. Diagnosis is usually established intraoperatively.ConclusionA malignancy of the appendix should always be in the differential diagnosis of a right inguinal mass, in order to provide optimum surgical treatment.     

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 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.     

腹腔镜腹膜外疝修补术治疗小儿滑动性腹股沟斜疝10例疗效

目的探讨小儿滑动疝的临床特点及腹腔镜下经皮腹膜外疝囊高位结扎术治疗小儿腹股沟滑动疝的临床效果。 方法回顾性分析2014年3月至2016年2月,滨州医学院附属医院收治的283例腹腔镜腹膜外疝修补术治疗儿童腹股沟疝患者的临床资料,其中10例为滑动疝。对手术时间、术中出血、住院时间、手术并发症及术后复发率等指标进行统计学分析。 结果本组10例患儿均顺利完成手术,无中转腹股沟路径手术病例,手术时间25～60（37.6±13.1）min;术中出血2～10（3.95±2.26）ml;住院时间5～7（5.6±0.8）d。术中发现对侧隐匿疝2例,以同法处理。术后无阴囊积血、积液、腹痛发生。本组10例患儿均获随访,随访时间6～18个月,无复发病例。 结论小儿滑动性腹股沟斜疝多为Bendavid Ⅱ型,小儿腹股沟管短直,腹腔镜直视下疝内容物易于还纳复位和了解疝类型,避免脏器损伤。疝内容物充分还纳腹腔并高位结扎疝囊是预防复发的关键。腹腔镜经皮腹膜外疝修补术治疗儿童腹股沟滑动疝近期效果安全、有效,远期疗效有待于进一步随访观察。     

Case Report: a Rare Case of Amyand’s Hernia Presenting in a 3-year-old Male Child

The finding of the vermiform appendix in an inguinal hernia has an incidence of approximately 1 %. The condition is given the eponymous name “Amyand’s hernia.” However, in just 0.08 %, the condition is complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix, and is most often misdiagnosed as an incarcerated inguinal hernia. As such, it is rarely recognized prior to surgical exploration. We report a case of Amyand’s hernia in a 3-year-old child who presented as a right-sided congenital hernia with pain in the right groin. He underwent herniotomy, which revealed that the hernia sac containing elongated inflamed appendix appeared with some adhesions to sac, lying in the inguinal canal.     

A rare presentation of Amyand's hernia. Case report and review of the literature

Amyand's hernia is defined as an inguinal hernia within the hernial sac containing the appendix. It is a rare disease, reported in 1% of cases of inguinal hernia repair. The appendix can be complicated by acute appendicitis in 0.13% of cases. This disease is often very difficult to diagnose, and most of the time it can be confused with an incarcerated or strangulated inguinal hernia. Often, it requires an emergent surgical treatment. This article describes the case of a 82-year-old female who was admitted for an intestinal obstruction and a bulge in the right inguinal region. An abdominal computed tomography scan showed dilated small bowel loops with multiple air/liquid levels and one loop herniating into the right inguinal canal. The patient underwent a laparotomy that showed the presence of an acute appendicitis and a necrotized ileal loop protruding into the right inguinal canal. The patient underwent an appendectomy and small bowel resection and she was discharged on postoperative day 10. Amyand's hernia can be a challenge for the surgeon. Its treatment depends on the grade of inflammation of the appendix. In fact, it can range from the simple repair of the abdominal defect with a prosthetic mesh, to appendectomy, small bowel resection and repair of the abdominal wall defect without a mesh.     

Incarcerated vermiform appendix in a left-sided inguinal hernia

We report here of a patient with an incarcerated vermiform appendix occurring in a left-sided indirect inguinal hernia. Occasionally, appendices are found in a hernial sac; however, the finding of an incarcerated vermiform appendix in an inguinal hernia on the left side is very unusual and has only been previously described once. The patient suffering this rare entity underwent appendectomy and repair of the hernia and experienced an uneventful postoperative recovery. The possibility of the presence of a situs inversus, or malrotation, as an underlying cause for the observed pathology was excluded by x-ray examination.     

Perforated appendix in hernial sac mimicking torsion of undescended testis in a neonate

In pediatric surgical practice, finding of the vermiform appendix in an inguinal hernia sac is not that uncommon; however, a perforation is rare. There are only a few case reports of a perforated appendix with periappendicular abscess in the inguinal hernial sac in a neonate. We report an unusual case of inguinal hernia containing a perforated appendix that was clinically mimicking testicular torsion of the undescended testis.     

De Garengeot hernia: Case report and review

IntroductionRene De Garengeot, a French surgeon, was the first to describe the presence of the appendix inside a femoral hernia sac in 1731. It is a rare entity that has fewer than 100 cases reported in literature.Presentation of caseAn 86 years-old male patient, comes to Emergency Department complaining of painful bulging in the right inguinal region, associated with local inflammatory signs. He was initially diagnosed as incarcerated femoral hernia and underwent emergency open surgery. Inguinotomy was performed and after hernia sac dissection it was possible to observe the presence of the appendix incarcerated in its interior, without clinical signs of appendicitis. Surgeons performed appendectomy and inguinal repair of the femoral hernia with placement of a polypropylene mesh.DiscussionDe Garengeot hernia is a rare entity that requires early treatment in order to avoid possible complications. When facing a patient with incarcerated hernia emergency surgery must be indicated even if it is not possible to determine the contents of the hernia.ConclusionThis paper presents a case report of a De Garengeot hernia patient who presented a good evolution after surgery.     

Laparoscopic reduction of Amyand's hernia

Summary The discovery of a vermiform appendix in an inguinal hernia sac is not uncommon, occurring in 1% of inguinal hernia repairs. However, the discovery of an acutely inflamed appendix within any hernia sac occurs in only 0.13% of cases. This rare finding is known as Amyand's hernia. We present a case of Amyand's hernia which was diagnosed preoperatively by CT scan and was reduced laparoscopically.     

Acute appendicitis presenting as an abdominal wall abscess: A case report

IntroductionAmyand hernia (AH) is a rare type of hernia characterized by the presence of appendix vermiformis in the inguinal hernial sac. It is rarely reported in women.Presentation of caseWe presented a case of a 60- year old woman who was admitted initially with an abdominal wall abscess and found to have perforated appendix in the right inguinal hernia. The patient underwent standard open appendectomy and the post-operative course was uneventful.DiscussionThe initial presentation of our case as an abdominal wall abscess is rare in the contemporary literature.ConclusionsA high index of suspicious, early diagnosis and timely surgical intervention are the keys to have favorable outcome in amyand hernia. The management should follow general guidelines of appendectomy, hernia repair and dealing with the associated pathology if present.     

Uncommon content in groin hernia sac

Groin hernia may have very unusual sac content. Vermiform appendix, acute appendicitis, ovary, fallopian tube and urinary bladder have been rarely reported. We aimed to present our experience with these unusual hernia contents. Records of 1,950 groin hernia patients were retrospectively analyzed. Vermiform appendix was found in 0.51% and acute appendicitis was found in 0.10% of groin hernia sacs. The incidence of appendix in femoral hernia was 5%, while inguinal hernia sac contained ovary and fallopian tube in 2.9% of the cases. The incidence of groin hernias containing urinary bladder was 0.36%. We also had 1 patient with incarcerated bladder diverticula in an indirect hernia sac. Iatrogenic bladder injury occurred in 2 patients. Although rare, a groin hernia sac may contain vermiform appendix and exceptionally acute appendicitis. Tubal and ovarian herniation in inguinal hernias can be found in adult and perimenopausal women with an incidence as high as in children. Urinary bladder hernia occurs with a similar incidence of tuba-ovarian hernia, however, it requires special attention because of a high risk of iatrogenic bladder injury during the inguinal dissection. Every effort should be made to preserve the organ found in hernia sac for an uneventful postoperative period.     

Amyand’s hernia: a report of 18 consecutive patients over a 15-year period

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.     

Amyand hernia: what lies beneath--a proposed classification scheme to determine management

Acute appendicitis in a hernia sac occurs exceptionally. An 80-year-old male patient underwent emergency surgery for an incarcerated right inguinal hernia found to contain a gangrenous appendix. His brief improvement after an emergency herniotomy with appendectomy was followed by intestinal obstruction caused by advanced colon cancer. The unique features and individualized management of the four published types of Amyand hernia are reviewed. Rather than simply being an anatomical curiosity, Amyand hernias require individualized attention to decide how to manage both the appendix and the hernia. Clinical scrutiny, a high index of suspicion for surgical comorbidities, and a common sense approach may improve outcomes.     

Endoscopic total extraperitoneal management of Amyand’s hernia

Presence of an appendix in a hernial sac (Amyands hernia) is a rare entity, still rarer is an inflamed appendix within the hernial sac. An endoscopic total extraperitoneal repair of a right-sided incarcerated inguinal hernia is described. The inguinal hernial sac contained an inflamed appendix. An associated small incisional hernia at the lower end of a midline suprapubic scar for a Millins prostatectomy was simultaneously repaired.     

A case of incarcerated femoral hernia in an infant

The authors describe the case of an incarcerated femoral hernia in an infant. A 4-month-old female infant was hospitalized with an incarcerated right groin hernia. Attempts to reduce the mass were unsuccessful, so an emergency surgery was performed. During surgery, the hernial sac seemed to protrude under the inguinal ligament. The authors opened the hernial sac and observed a dark red small intestine. The authors did not resect the intestine because its color gradually improved after the constriction was released. The hernial sac passed under the inguinal ligament, and the infant was diagnosed with incarcerated femoral hernia.     

De Garengeot’s hernia: Case report of appendicitis within an incarcerated femoral hernia

We present the case of a 64-year-old Caucasian female who was admitted to our emergency department with a 3-day history of a painful mass in her right inguinal area. The lump had increased in size over the previous two days and an overlying skin discoloration was also noted. With the diagnosis of an incarcerated hernia, an infrainguinal incision was carried out and a femoral hernia containing an inflamed appendix was identified, a rare condition known as de Garengeot’s hernia. This is a rather uncommon finding at surgery that is seldom diagnosed in the preoperative context.