Amyand hernia

Clinical History

50-year-old male patient with a history of hypertension presented with acute onset of chest and epigastric pain. Afebrile and normal infection parameters. Aortic dissection was suspected and CT aorta with iv contrast in arterial phase was performed, which excluded dissection. An incidental finding was seen unrelated to the patient's actual problem.

Imaging Findings

CT aorta with intravenous contrast agent was performed in arterial phase with multiplanar reconstructions. No aorta pathology or dissection was found as clinically suspected. A right-sided inguinal hernia containing a thin-walled, gas-containing, non-inflamed vermiform appendix was found as incidental finding.

Discussion

Background:

The presence of the vermiform appendix in an inguinal hernial sac is called “Amyand” Hernia, which is an uncommon condition, reported in 1% of cases of inguinal hernia repair. The appendix can be complicated by acute appendicitis in 0.13% of cases. [1]

Claudius Amyand (1681 to 1740)—a French sergeant surgeon to King George performed the first successful appendectomy in an 11-year-old boy with a perforated appendix in the right inguinal hernia sac in 1735. This condition is named after him. [2]

Clinical Perspective, Imaging perspective and Outcome:

Without any preference for age group or sex, cases of Amyand hernia have been reported in the range from a neonatal period to 92 years of age, more commonly in children because of a patent vaginal process. [3] The hernias are commonly right-sided, reflecting the usual intra-abdominal position of the organ, but a few left-sided Amyand hernias have been reported, surprisingly none of them were associated with intestinal malrotation. [4]

Preoperative diagnosis is challenging as patients with Amyand hernia usually present with symptoms and signs of complicated inguinal hernia (incarcerated or strangulated inguinal hernia), that is why it has been usually diagnosed intraoperatively.² The trend is changing due to increasing use of CT.

Treatment is challenging for surgeons and can range from only repair of the abdominal wall defect to appendectomy depending upon the grade of inflammation. [1] In cases of a grossly normal vermiform appendix, appendectomy may be controversial.

Teaching Points:

Amyand hernia is a rare condition and standardisation of treatment is still ongoing, which began with Losanoff and Basson classification. [3] Ultrasonography (USG) and contrast-enhanced computed tomography (CECT) are the helpful investigations to diagnose it preoperatively and guide the surgical plan.

Differential Diagnosis List

Final Diagnosis

Amyand hernia

URL:	https://www.eurorad.org/case/13673
DOI:	10.1594/EURORAD/CASE.13673
ISSN:	1563-4086