953 Amyand's Hernia: The Fortuitous Intraoperative Diagnosis – a Case Report

Abstract Introduction Amyand's hernia is a very rare form of inguinal hernia, in which the vermiform appendix is in the inguinal canal/hernia sac. Its incidence is less than 1% of groin hernias and is complicated by appendicitis in about 0.1% of cases. It is commoner in males, on the right side and has a bimodal age distribution – neonates and the elderly. We present the case of an elderly gentleman with amyand's hernia diagnosed intraoperatively. Case Presentation A 78-year-old male with a background of systemic hypertension presented to the clinic with an 18-month history of painless right groin swelling. Physical examination revealed a full, non-tender abdomen. He had a 4cm soft, reducible right groin swelling, with visible and palpable cough impulse. A diagnosis of right inguinal hernia was made. Baseline blood workup and ECG were unremarkable. He was listed for a day case open hernia repair. Intra-operatively, the right indirect hernia sac contained a grossly uninflamed appendix lying freely within it. Figure 1. Appendicectomy was performed and a tension-free repair was done. The post-operative period was uneventful. Histology of the excised appendix revealed reactive lymphoid hyperplasia and submucosal fibrosis. Conclusion As only about 1 in 60 cases of Amyand's hernia are diagnosed pre-operatively, usually as an incidental finding on imaging; the overwhelming majority are intra-operative findings. Although rare, the vermiform appendix remains a possible content of the inguinal hernia sac, and it is important to be aware of likely complications and options of repair.