Clinical History
The patient was known to have sigmoid carcinoma and was on follow-up to identify local and distant spread of disease. No abdominal complaints. Apart from multiple lung nodules and multiple metastatic lesions in the liver, an incidental finding was also noted.
Imaging Findings
Axial (Fig. 1 a), sagittal (Fig. 1 b, c, d) and coronal (Fig. 1 e, f) images show the normal calibre vermiform appendix within the right indirect inguinal hernia. The hernia is seen passing lateral to the inferior epigastric artery, suggesting its indirect nature (Fig. 1 g).
Discussion
Amyand's hernia is a rare form of inguinal hernia containing the vermiform appendix, occurring in less than 1% of inguinal hernias [1]. Its counterpart is the De Garengeot's hernia, where the appendix is located within a femoral hernial sac. According to the definition, the appendix does not have to be inflamed, to be labelled as an Amyand type hernia [2]. It is always important to classify it as direct or indirect. The landmark for demarcation is the inferior epigastric artery. If the hernia is medial to the artery, then it is the direct type. If the hernia is lateral to the artery, then it is the indirect type.
This patient´s hernia was an incidental finding, however, the decision to correct the hernia was left to the surgeon.
This condition is commonly misdiagnosed as an incarcerated hernia. If the appendix is inflamed then a stepwise procedure is performed, appendectomy followed by hernial mesh repair [2].
Differential Diagnosis List
Indirect Amyand's hernia
De Garengeot\'s Hernia
Strangulated hernia
