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Informative Article | General Surgery | India | Volume 13 Issue 4, April 2024 | Popularity: 5.8 / 10

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Strangulated Amyand Hernia and Gangrene of Right Testis

Dr. Rajat Gupta, Dr. Ramendra Kumar Jauhari

Abstract: Background: Amyand hernia is a type of inguinal hernia that contains the vermiform appendix in its sac and is reported to have prevalence of 0.9 - 1.7% of all inguinal hernia cases. Inflammation and strangulation is extremely rarer and constitutes around 0.1% of all amyand hernia cases. Though the preoperative diagnosis is difficult in case of strangulated amyand hernia, it is usually an incidental intraoperative finding. Ulltrasound scan and contrast enhanced computed tomography may help in establishing the diagnosis pre - operatively if the patient condition allows us to perform. Clinical Case: A 72 - year - old male with history of right inguinal hernia, who is complaining of irreducible swelling 10 days prior to admission characterized by pain and fluctuating mass in right inguinal region. The patient was planned for urgent surgical intervention along with right inguinal herniorraphy, showing a gangrenous appendix with cecal perforations and gangrenous right testis as an intraoperative finding, along with purulent collection of around 100ml in right scrotum. Ileocecal resection with right high inguinal orchidectomy was performed by laparotomy and right inguinal herniorraphy with Bassini technique without apparent complications. Post - operatively the patient was managed in AEICU and adequate recovery was noticed. Conclusion: Most of the cases of amyand hernia are diagnosed intraoperatively and a preoperative diagnosis is rarely made. Management should be individualized according to appendix' inflammation stage, presence of abdominal sepsis, and comorbidity factors. The decision should be based on factors such as the patient's age, the size and anatomy of the appendix, and in case of appendicitis, standard appendectomy and herniorrhaphy without a mesh should be the standard of care. If the appendix is found to be inflamed, the chances of morbidity and mortality increases. Amyand's hernia is commonly misdiagnosed as an ordinary incarcerated hernia.

Keywords: Amyand Hernia; Appendicitis; ileocecal resection; strangulation

Edition: Volume 13 Issue 4, April 2024

Pages: 1912 - 1914

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