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Amyand's hernia with appendicular perforation: A case series
摘要
Introduction: Amyand's hernia is an uncommon variant of inguinal hernias, which is defined by the presence of the appendix within the hernia sac. They can be classified into four types. There is not much literature about the subject and some issues remain controversial, such as the treatment options. Over 16 years (1996-2012) 2648 inguinal hernias were surgically intervened at Hospital Distrital da Figueira da Foz, Portugal, and two of them were Amyand's hernias representing an incidence of 0.076%. Case Series: The patients are males, 72 and 76 years old, and presented right inguinal pain and tumor. In both cases, the diagnosis was made during emergency surgery and perforated appendicitis was found. Appendectomy through the herniotomy incision and primary prosthetic hernia repair with associated endovenous broadspectrum antibiotic therapy was the treatment of choice. No significant morbidity or mortality was recorded. Conclusion: The adequate surgical treatment depends on the type of Amyand's hernia. Appendectomy through the herniotomy incision and primary hernia repair seems to be the best treatment option for Amyand´s hernia with acute appendicitis. The method of primary hernia repair is, however, controversial. Some authors stand for a prosthetic hernia repair and endovenous broad-spectrum antibiotic therapy, with good results. Appendectomy is not an absolute contraindication to primary prosthetic hernia repair. More studies are needed to acknowledge the best surgical approach concerning the different types of Amyand's hernia.