Management of a Patient With an Obstructed Inguinal Hernia With Amyand's Variety: A Report of a Rare Case With a Review of the Literature.

Abstract

Amyand's hernia is a rare form of inguinal hernia, where the appendix is located within the inguinal sac. A 66-year-old male presented with an obstructed, incarcerated right inguinal hernia. He underwent an emergency herniotomy under spinal anesthesia. Intraoperatively, the hernia sac contained a viable small bowel and part of the appendix. As the appendix appeared mildly inflamed, an appendicectomy was performed, and a synthetic mesh repair was done. He received a postoperative course of antibiotics and was discharged home on day 3 after an uneventful recovery. Histology of the appendix revealed a fecolith in the absence of acute inflammation. He did not have any procedure-related complications on follow-up. Preoperative diagnosis of Amyand's hernia is a challenge due to nonspecific symptoms and rarity. Lasanoff and Basson classify Amyand's hernia and provide surgical guidance for its management. Our case belonged to the type 2 category. Management of Amyand's hernia needs an individually tailored approach rather than strict adherence to conventional guidelines. The presence of an appendicular fecolith in the absence of inflammation provides an interesting area to explore in an Amyand's hernia.