Amyand hernia--a rare anatomic and clinical entity diagnosed intraoperatively

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.