Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website

Case Report

Volume 6, Number 12, December 2015, pages 592-595

Incarcerated Amyand’s Hernia With Acute Appendicitis: A Case Report


Figure 1.
Figure 1. Preoperative kidney, ureter, and bladder X-ray indicated to rule out small bowel obstruction caused by hernia. No dilated bowel loops and a moderate amount of air can be seen, suggestive of non-obstructive bowel gas pattern.
Figure 2.
Figure 2. Intraoperatively signs were suggestive of acute appendicitis within the inguinal hernia sac. An inflamed appendix and mesoappendix could be seen once the hernia sac had been dissected.


Table 1. Hernia Types Reported That Included Vermiform Appendix, With the Number of Reported Cases for Each Hernia Type. Adapted From [8]
Hernia typeNumber of cases
Incarcerated inguinal hernia113
Strangulated inguinal hernia11
Incarcerated femoral hernia30
Strangulated femoral hernia11
Umbilical hernia4
Strangulated obturator hernia3
Incarcerated Spiegel hernia3
Strangulated diaphragmatic hernia7
Incisional hernia2
Epigastric hernia2
Strangulated internal hernia1
Strangulated paradouodenoal hernia1


Table 2. Classification, description, and suggested management of Amyand’s Hernia (Adapted From Losanoff and Basson [1])
ClassificationDescriptionSurgical management
Type 1Normal appendix within inguinal herniaHernia reduction, mesh repair, appendectomy in young patients
Type 2Acute appendicitis within an inguinal hernia, no abdominal sepsisAppendectomy through hernia, primary endogenous repair of hernia, no mesh
Type 3Acute appendicitis within an inguinal hernia, abdominal wall or peritoneal sepsisLaparotomy, appendectomy, primary repair of hernia, no mesh
Type 4Acute appendicitis within an inguinal hernia, related or unrelated abdominal pathologyManage as types 1 to 3, investigate or treat second pathology as appropriate


Table 3. Surgical Pathology Report From Intraoperative Appendix Tissue Sample Revealing Acute Appendicitis
Tissue submittedDescription
AppendixReceived in formalin fixative and labeled appendix. It consists of an appendix measuring approximately 8.0 cm in length and from 1.0 to 2.0 cm in diameter. The serosal surface is gray/tan and shows patchy areas with tan/gray fibrinous exudates. The distal end shows a shaggy irregular appearance. There is attached mesoappendix and at the distal end, an attached portion of fibromembranous-like tissue measuring approximately 5.0 × 3.0 × 0.3 cm.
On sectioning, the lumen measures from 0.2 to 0.5 cm. and contains dark brown fecal material. Also received in the same container is a separate portion of similar appearing fibrous-like tissue measuring 3.0 × 1.0 × 0.3 cm.
Final diagnosis:
Appendix, appendectomy:
Acute transmural appendicitis and periappendicitis