A Rare Variation Of Amyand's Hernia: Gangreneous Appendicitis In An Incarcerated Inguinal Hernia Sac

Claudius Amyand first described in 1735 the presence of a vermiform appendix within an inguinal hernia sac, and since then this entity has carried his name as "Amyand's hernia". The incidence of normal appendix within an inguinal hernia sac is estimated to be approximately 1%, whereas acute appendicitis presenting in an inguinal hernia is an uncommon event (0.1% of all cases of appendicitis). We report a case of gangrenous appendicitis in an incarcerated inguinal hernia and further discuss the features of this condition and suggest that extraluminal compression caused by incarceration may be a predisposing factor for appendicitis. In conclusion, acute appendicitis within an Amyand's hernia can be life threatening and the patients always require emergency surgery. We recommend appendectomy after groin exploration through an inguinal incision, and tension-free herniorrhaphy in cases gangrenous acute appendicitis in incarcerated Amyand's hernia.

Keywords
Amyand hernia, gangrenous appendicitis, incarceration, inguinal hernia, Rutkow herniorrhaphy