Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Med Case Rep. 2024 Mar 30;18(1):194. doi: 10.1186/s13256-023-04340-y.
Amyand's hernia (AH) is an appendix (with or without acute inflammation) trapped within an inguinal hernia. Most AH with acute appendicitis had a preexisting appendix within the hernia sac. We herein report a variant of AH that has never been described before. An inflamed appendix that was managed conservatively was found to have migrated and trapped in the sac of a previously unrecognized right inguinal hernia 6 weeks after the index admission, resulting in a secondary Amyand's hernia.
A 25-year-old healthy Taiwanese woman had persistent right lower abdominal pain for 1 week and was diagnosed with perforated appendicitis with a localized abscess by abdominal computed tomography (CT). No inguinal hernia was noted at that time. Although the inflamed appendix along with the abscess was deeply surrounded by bowel loops so that percutaneous drainage was not feasible, it was treated successfully with antibiotics. However, she was rehospitalized 6 weeks later for having a painful right inguinal bulging mass for a week. Abdominal CT revealed an inflamed appendix with abscess formation in an indirect inguinal hernia raising the question of a Amyand's hernia with a perforated appendicitis. Via a typical inguinal herniorrhaphy incision, surgical exploration confirmed the diagnosis, and it was managed by opening the hernial sac to drain the abscess and reducing the appendix into the peritoneal cavity, followed by conventional tissue-based herniorrhaphy and a laparoscopic appendectomy. She was then discharged uneventfully and remained well for 11 months.
Unlike the traditional definition of Amyand's hernia, where the appendix is initially in the hernia sac, the current case demonstrated that Amyand's hernia could be a type of delayed presentation following initial medical treatment of acute appendicitis. However, it can still be managed successfully by a conventional tissue-based herniorrhaphy followed by laparoscopic appendectomy.
Amyand 疝（AH）是指阑尾（伴有或不伴有急性炎症）嵌顿于腹股沟疝中。大多数伴有急性阑尾炎的 AH 均有先前存在于疝囊内的阑尾。我们在此报告一种以前从未描述过的 AH 变异型。一例经保守治疗的发炎阑尾被发现已迁移并嵌顿于先前未识别的右侧腹股沟疝囊内，这是在指数入院后 6 周发生的继发性 Amyand 疝。
一名 25 岁的健康台湾女性因右下腹痛持续 1 周就诊，腹部 CT 诊断为穿孔性阑尾炎伴局限性脓肿。当时未发现腹股沟疝。尽管发炎的阑尾与脓肿被肠袢深深地包围，使得经皮引流不可行，但抗生素治疗成功。然而，她在 6 周后因右下腹股沟膨出性肿块疼痛 1 周而再次入院。腹部 CT 显示存在炎症性阑尾和脓肿形成于腹股沟斜疝，提出了 Amyand 疝伴穿孔性阑尾炎的问题。通过典型的腹股沟疝修补切口，手术探查证实了这一诊断，并通过打开疝囊以排出脓肿并将阑尾还纳入腹腔，然后进行常规组织型疝修补和腹腔镜阑尾切除术来进行处理。随后她顺利出院，11 个月后情况良好。
与传统的 Amyand 疝定义不同，即阑尾最初位于疝囊内，本病例表明 Amyand 疝可能是急性阑尾炎初始内科治疗后的一种迟发性表现。然而，它仍然可以通过常规组织型疝修补术联合腹腔镜阑尾切除术成功治疗。
