An approach to the management of Amyand's hernia and presentation of an interesting case report.
BACKGROUND
Inguinal hernia is one of the most common operations and 1% of the cases contain appendix in the hernial sac, which is known as Amyand's hernia. Inflamed appendix and its presence in recurrent inguinal hernia is a rare encounter in general surgery. The management of Amyand's hernia is not straightforward without awareness.


METHODS
Recurrent inguinal hernia with Amyand's hernia history, clinical features and management was studied and compared with the present literature. We have discussed the management options and an approach using a Medline literature review.


RESULTS
An 80-year-old gentleman who had a right-side inguinal hernia operated 40 years ago presented with a right groin swelling and increasing redness associated with pain for 3 days. Clinical signs and symptoms were in favour of strangulated inguinal hernia. He was operated and appendicectomy was done for inflamed non-perforated appendicitis. Prolene mesh repair was done and he was treated with a full course of antibiotics.


CONCLUSIONS
Amyand's hernia is difficult to diagnose pre-operatively and its presence in recurrent hernia has only been reported once before. The management of Amyand's hernia is not straightforward in most of the cases. Inflamed and perforated appendix needs to be removed. Delayed mesh repair is a better surgical option in perforated appendix cases.
Ranganathan
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Prince Philip Hospital, Hywel Dda NHS Trust, Block 7, Flat 4, Bryngwyn Mawr, Llanelli, SA14 8QF, Wales, UK. rganesh_ms@yahoo.com
Kouchupapy
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R
Dias
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S
D000369:Aged, 80 and over; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003657:Decision Making; D006552:Hernia, Inguinal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D013514:Surgical Procedures, Operative / Q000379:methods