INTRAOPERATIVELY DIAGNOSED TYPE 1 AMYAND HERNIA: SURGICAL CHALLENGE AND PROSTHETIC REPAIR STRATEGY. A CASE REPORT
Keywords:
Inguinal hernia; appendix; appendectomy; surgical mesh; case reportsAbstract
DOI: https://doi.org/10.46296/yc.v10i19.0948
Abstract
Background: Amyand hernia is defined by the presence of the vermiform appendix within an inguinal hernia sac. It is uncommon and, when preoperative imaging lacks specific findings, it is frequently discovered unexpectedly during inguinal hernia repair. Case presentation: A 41-year-old man presented with a 12-month history of a right inguinal bulge and intermittent burning pain triggered by physical effort. Examination showed a painful right inguinal defect that enlarged with the Valsalva maneuver and reduced spontaneously at rest, without gastrointestinal symptoms or fever. Ultrasonography demonstrated an approximately 19-mm reducible hernia sac without evidence of complication. Intervention and outcome: Elective open inguinal repair was performed. Opening of the hernia sac revealed the vermiform appendix, which was exteriorized and removed using the Pouchet appendectomy technique. A Lichtenstein repair with polypropylene mesh was then completed without drains. Recovery was uneventful and the patient was discharged on postoperative day 1. At one month, histopathology showed no inflammatory process in the appendix, supporting a Losanoff-Basson type 1 Amyand hernia. Conclusion: Amyand hernia may remain unrecognized during the preoperative assessment of an apparently uncomplicated inguinal hernia. The condition of the appendix and the degree of contamination should guide the decision regarding appendectomy and prosthetic repair. Mesh repair is accepted in type 1 cases, whereas removal of a non-inflamed appendix remains individualized.
Keywords: Inguinal hernia; appendix; appendectomy; surgical mesh; case reports.
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