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Archives of Medical Science
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vol. 13
Letter to the Editor

Incarcerated recurrent inguinal hernia containing an acute appendicitis (Amyand hernia): an extremely rare surgical situation

Georgios Velimezis
Nikolaos Vassos
Georgios Kapogiannatos
Dimitrios Koronakis
Evangelos Perrakis
Aristotelis Perrakis

Arch Med Sci 2017; 13, 3: 702–704
Online publish date: 2016/06/07
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Inguinal hernia is one of the most common surgical entities and often poses technical dilemmas, even for the experienced surgeon. It may contain segments of small and large bowel, the great omentum and in very rare cases the vermiform appendix [1]. The presence of the vermiform appendix within an inguinal hernia, with or without appendicitis, was first described by Amyand in 1736 [2]. Claudius Amyand, a French surgeon working in London, performed the first successful appendectomy in 1735 on an 11-year-old boy who presented with an inflamed, perforated appendix in his inguinal hernia sac. The entity of Amyand hernia has an incidence of 1% and is complicated by acute appendicitis in 0.08–0.13% of cases [3–5]. The pathophysiology of acute appendicitis in Amyand hernia is still controversial. It is usually caused by extraluminal obstruction due to pressure in the hernia neck rather than intraluminal obstruction of the appendix [3, 6]. Muscle contraction or any other sudden increase of intra-abdominal pressure may cause compression of the appendix, resulting in further inflammation [6, 7]. Its blood supply may be subsequently interrupted or significantly reduced, resulting in inflammation and bacterial overgrowth [3, 8]. We report a case of Amyand hernia in a recurrent inguinal hernia, presenting difficulties in diagnosis and treatment of this surgical problem.
A 78-year-old man was referred to the Department of Surgery, General Hospital of Western Attica, suffering from a pain in the right inguinal region without any further symptoms. The patient had a surgical history of hernia repair without mesh 12 years ago. Physical examination revealed a painful small mass in the right inguinal region with a scar on skin. Laboratory tests showed leucocytosis (16,500 white blood cells (WBC)/µl). The diagnosis of incarcerated recurrent hernia was established through the clinical findings and ultrasonography (US), and the patient was scheduled for emergency surgery. During surgery, an incarcerated vermiform appendix with acute catarrhal inflammation in the recurrent inguinal hernia was revealed. The appendix was not perforated (Figure 1). An appendectomy and a tension-free mesh repair with an e-polytetrafluoroethylene (e-PTFE) patch were performed [9]. Furthermore, antibiotic therapy with a 2nd generation cephalosporin for 3 days was administered. During the postoperative period there were no complications to register and the patient was discharged on the 5th...

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