AMYANDS HERNIA A Rare case report

Abstract

In 1735, Claudius Amyand, surgeon to King  Georges II, performed the first recorded appendectomy for a perforated appendicitis within the inguinal canal thus   Amyand's hernia became the term to describe appendicitis, an inflamed appendix or a non inflamed appendix within an inguinal hernia. The presence of the vermiform appendix contained in the hernia sac, or an Amyands hernia, is  exceedingly rare, occurring in 1 of inguinal hernia  patients. The incidence is estimated to be 1 of adult inguinal hernia repair, but the reported incidence of appendicitis in the inguinal sac is rarer and ranges between 0.08 to 0.13. we report the case of amyands hernia for its clinical presentation, management and rare entity. Mr.Boominathan, 56male,  Admitted in emergency as suspected case of obstructed right inguinal hernia, patient had inguinal hernia for 7 years and pain over the hernia for past 1 month and not reducing for past 15 days, on examination an oblong shaped right inguinal swelling of size 20x15x10 cm, manually partially reducible with gurgling, cough impulse present, diagnosed as                   Irreducible right inguinal hernia with enterocele and posted for elective hernioplasty, pain over the hernia subsided after antibiotic therapy. During surgery patient was found to have appendix without macroscopic evidence of acute inflammation in hernial sac Amyands type 1, hence appendicectomy and hernioplasty done, post operative period was uneventful, discharged in stable clinical condition, post operative   histopathological examination of appendix was acute  appendicitis ( Amyands type 2) .

The decision to perform an appendectomy orand use the mesh repair should always be individualized to the         patient. The decision as to whether one should perform a simultaneous appendectomy and hernia repair is                   multifactorial. It is important to be aware of all clinical settings and an appropriate and individualized approach should be applied. The presence or absence of inflammation of the appendix is a very important determinant of appropriate            treatment. In our case macroscopically no evidence of acute appendicitis hence mesh repair done, but microscopically

proved as acute appendicitis which is in hernial sac is a rare entity.