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Table of Contents   
CASE REPORT
Year : 2012  |  Volume : 17  |  Issue : 3  |  Page : 128-129
 

Amyand's hernia presenting as chronic scrotal sinus


Department of Pediatric Surgery, Dr. BL Kapur Memorial Hospital, New Delhi, India

Date of Web Publication6-Jul-2012

Correspondence Address:
Prashant Jain
Department of Pediatric Surgery, Dr. BL Kapur Memorial Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.98134

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   Abstract 

A rare case of Amyand's hernia in an infant who presented with chronic discharging scrotal sinus is reported.


Keywords: Amyand′s hernia, scrotal sinus, vermiform appendix


How to cite this article:
Jain P, Mishra A. Amyand's hernia presenting as chronic scrotal sinus. J Indian Assoc Pediatr Surg 2012;17:128-9

How to cite this URL:
Jain P, Mishra A. Amyand's hernia presenting as chronic scrotal sinus. J Indian Assoc Pediatr Surg [serial online] 2012 [cited 2018 May 28];17:128-9. Available from: http://www.jiaps.com/text.asp?2012/17/3/128/98134



   Introduction Top


The presence of vermiform appendix, whether inflamed or not, inside a hernia sac is called as Amyand's hernia. This rare condition constitutes 1% of all the inguinal hernias, whereas inflamed appendix is found in only 0.1% of the cases. [1] In pediatric patients, it can be mistaken for incarcerated/strangulated hernia, torsion of testis, or scrotal abscess.


   Case Report Top


A 1-year-old male child presented with a discharging sinus over the right hemiscrotum since the age of 3 months [Figure 1]. The child had a history of scrotal abscess, which got burst spontaneously, followed by intermittent episodes of pus discharge. The right spermatic cord was thickened and tender. An impulse on cry was present suggestive of inguinal hernia. The sinus could not be cannulated. The ultrasound of the right inguinoscrotal area revealed bowel herniation. A diagnosis of inguinal hernia with some bizarre congenital fistula was made. On inguinal exploration, there was a sliding hernia with cecum and appendix herniating into the sac. Grossly the appendix appeared to be edematous. It was densely adherent to the scarred sinus in the upper scrotum [Figure 2]. The right testis was slightly bulky and spermatic cord was thickened. The appendix adherent to the scrotal sinus was dissected. Appendicectomy followed by herniotomy was done. The postoperative period was uneventful and the child is asymptomatic at 1-year followup. Histopathology of the appendix revealed acute inflammation.
Figure 1: Scrotal sinus

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Figure 2: Sliding hernia with herniation of cecum and the appendix. Appendix separated from the scrotal sinus

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   Discussion Top


Amyand's hernia, although rare, is a well-known entity. It has been classified according to the degree of inflammation of appendix: (a) noninflamed, (b) inflamed, or (c) perforated appendix. [2] In a largest series of 30 cases of Amyand's hernia in children reported by Kaymakci et al., [3] the incidence of the condition was reported as 0.42%, whereas that of inflamed appendices as 0.07%. Preoperative diagnosis of this condition is difficult. Although rare, the possibility should always be kept in mind in cases of acute scrotum. It may be mistaken for incarcerated/strangulated hernia, or torsion of testes. Various reports of incarcerated inguinal hernia with fecal discharge have been reported in the literature. [4],[5] Interestingly, the boy for whom the first appendicectomy was done by Claudius Amyand also had scrotal fistula. [6] Sliding appendiceal inguinal hernia in children is even more rare. [7],[8] Preoperative diagnosis in this condition is rare. Although not frequently used, ultrasound and computed tomography can be helpful in diagnosing such cases. [9] The condition should be strongly suspected when there is finding of tender hernia without radiologic or clinical signs of obstruction. [10]

The surgical options for tackling the appendix in an Amyand's hernia depend on the mode of presentation. Reports of larger series of Amyand's hernia in pediatric patients concludes that the presence of a normal appendix does not require appendicectomy, whereas acute appendicitis necessitates appendicectomy within the hernial sac. [3],[11],[12]

Complications, such as wound infection, epididymitis, and urinary retention have been reported. Recurrence of the hernia is always a possibility, especially in the cases of perforated appendix, appendicular abscess, and after surgical site wound infection. Mortality varies between 14% and 30%; risk being mostly associated with perforated appendix with or without periappendicular abscess formation and peritonitis. [4] The clinical awareness and strong suspicion of this entity can prevent the associated morbidity and mortality.

 
   References Top

1.Logan MT, Nottingham JM. Amyand's hernia: A case report of an incarcerated and perforated appendix within an inguinal hernia and review of the literature. Am Surg 2001;67:628-9.  Back to cited text no. 1
[PUBMED]    
2.Fernando J, Leelaratna S. Amyand's hernia. Ceylon Med J 2002;47:71.  Back to cited text no. 2
[PUBMED]    
3.Kaymakci A, Akillioglu I, Akkoyun I, Guven S, Ozdemir A, Gulen S. Amyand's hernia: A series of 30 cases in children. Hernia 2009;13:609-12.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Meinke AK. Review article: Appendicitis in groin hernias. J Gastrointest Surg 2007;11:1368-72.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Ameh EA, Awotula OP, Amoah JN. Spontaneous scrotal faecal fistula in infants. Pediatr Surg Int 2002;18:524-5.  Back to cited text no. 5
    
6.Amyand C. Of an inguinal rupture, with a pin in the appendix caeci, incrusted with stone; and some observations on wounds in the guts. Philos Trans R Soc Lond 1736;39:329-36.  Back to cited text no. 6
    
7.Oguzkurt P, Kayaselcuk F, Oz S, Arda IS, Oguzkurt L. Sliding appendiceal inguinal hernia with a congenital fibrovascular band connecting the appendix vermiformis to the right testis. Hernia 2001;5:156-7.  Back to cited text no. 7
    
8.Weber RV, Hunt ZC, Kral JG. Amyand's hernia: Etiologic and therapeutic implications of two complications. Surg Rounds 1999;22:552-6.   Back to cited text no. 8
    
9.Luchs JS, Halpern D, Katz DS. Amyand's hernia: Prospective CT diagnosis. J Comput Assist Tomogr 2000;24:884-6.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Davies MG, O' Byrne P, Stephens RB. Perforated appendicitis presenting as an irreducible inguinal hernia. Br J Clin Pract 1990;44:494-5.  Back to cited text no. 10
    
11.Cankorkmaz L, Ozer H, Guney C, Atalar MH, Arslan MS, Koyluoglu G. Amyand's hernia in the children: A single centre experience. Surgery 2010;47:140-3.  Back to cited text no. 11
    
12.Sharma H, Gupta A, Shekhawat N, Memon B, Memon M. Amyand's hernia: A report of 18 consecutive patients over a 15-year period. Hernia 2007;11:31-5.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]


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    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

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