J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 6, Number 12, December 2015, pages 592-595

Incarcerated Amyand’s Hernia With Acute Appendicitis: A Case Report

Figure 1. Preoperative kidney, ureter, and bladder X-ray indicated to rule out small bowel obstruction caused by hernia. No dilated bowel loops and a moderate amount of air can be seen, suggestive of non-obstructive bowel gas pattern.

Figure 2. Intraoperatively signs were suggestive of acute appendicitis within the inguinal hernia sac. An inflamed appendix and mesoappendix could be seen once the hernia sac had been dissected.

**Table 1.** Hernia Types Reported That Included Vermiform Appendix, With the Number of Reported Cases for Each Hernia Type. Adapted From [8]
Hernia type	Number of cases
Incarcerated inguinal hernia	113
Strangulated inguinal hernia	11
Incarcerated femoral hernia	30
Strangulated femoral hernia	11
Umbilical hernia	4
Strangulated obturator hernia	3
Incarcerated Spiegel hernia	3
Strangulated diaphragmatic hernia	7
Incisional hernia	2
Epigastric hernia	2
Strangulated internal hernia	1
Strangulated paradouodenoal hernia	1
Total	188

Table 1. Hernia Types Reported That Included Vermiform Appendix, With the Number of Reported Cases for Each Hernia Type. Adapted From [8]

Hernia type

Number of cases

Incarcerated inguinal hernia

113

Strangulated inguinal hernia

Incarcerated femoral hernia

Strangulated femoral hernia

Umbilical hernia

Strangulated obturator hernia

Incarcerated Spiegel hernia

Strangulated diaphragmatic hernia

Incisional hernia

Epigastric hernia

Strangulated internal hernia

Strangulated paradouodenoal hernia

Total

188

**Table 2.** Classification, description, and suggested management of Amyand’s Hernia (Adapted From Losanoff and Basson [1])
Classification	Description	Surgical management
Type 1	Normal appendix within inguinal hernia	Hernia reduction, mesh repair, appendectomy in young patients
Type 2	Acute appendicitis within an inguinal hernia, no abdominal sepsis	Appendectomy through hernia, primary endogenous repair of hernia, no mesh
Type 3	Acute appendicitis within an inguinal hernia, abdominal wall or peritoneal sepsis	Laparotomy, appendectomy, primary repair of hernia, no mesh
Type 4	Acute appendicitis within an inguinal hernia, related or unrelated abdominal pathology	Manage as types 1 to 3, investigate or treat second pathology as appropriate

Table 2. Classification, description, and suggested management of Amyand’s Hernia (Adapted From Losanoff and Basson [1])

Classification

Description

Surgical management

Type 1

Normal appendix within inguinal hernia

Hernia reduction, mesh repair, appendectomy in young patients

Type 2

Acute appendicitis within an inguinal hernia, no abdominal sepsis

Appendectomy through hernia, primary endogenous repair of hernia, no mesh

Type 3

Acute appendicitis within an inguinal hernia, abdominal wall or peritoneal sepsis

Laparotomy, appendectomy, primary repair of hernia, no mesh

Type 4

Acute appendicitis within an inguinal hernia, related or unrelated abdominal pathology

Manage as types 1 to 3, investigate or treat second pathology as appropriate

**Table 3.** Surgical Pathology Report From Intraoperative Appendix Tissue Sample Revealing Acute Appendicitis
Tissue submitted	Description
Appendix	Received in formalin fixative and labeled appendix. It consists of an appendix measuring approximately 8.0 cm in length and from 1.0 to 2.0 cm in diameter. The serosal surface is gray/tan and shows patchy areas with tan/gray fibrinous exudates. The distal end shows a shaggy irregular appearance. There is attached mesoappendix and at the distal end, an attached portion of fibromembranous-like tissue measuring approximately 5.0 × 3.0 × 0.3 cm. On sectioning, the lumen measures from 0.2 to 0.5 cm. and contains dark brown fecal material. Also received in the same container is a separate portion of similar appearing fibrous-like tissue measuring 3.0 × 1.0 × 0.3 cm. Final diagnosis: Appendix, appendectomy: Acute transmural appendicitis and periappendicitis

Table 3. Surgical Pathology Report From Intraoperative Appendix Tissue Sample Revealing Acute Appendicitis

Tissue submitted

Description

Appendix

Received in formalin fixative and labeled appendix. It consists of an appendix measuring approximately 8.0 cm in length and from 1.0 to 2.0 cm in diameter. The serosal surface is gray/tan and shows patchy areas with tan/gray fibrinous exudates. The distal end shows a shaggy irregular appearance. There is attached mesoappendix and at the distal end, an attached portion of fibromembranous-like tissue measuring approximately 5.0 × 3.0 × 0.3 cm.
On sectioning, the lumen measures from 0.2 to 0.5 cm. and contains dark brown fecal material. Also received in the same container is a separate portion of similar appearing fibrous-like tissue measuring 3.0 × 1.0 × 0.3 cm.
Final diagnosis:
Appendix, appendectomy:
Acute transmural appendicitis and periappendicitis