Mr Tarik Ibrahem Ali
Introduction: Acute appendicitis is a common condition most often occurring in children and young people. A Congenital Inguinal Hernia is also a common condition to be presented at the surgical clinics, when the hernial contents are usually found to be either a Loop of Bowel, Appendix, Bladder or Omentum, but for it to be presented as an Incarcerated Congenital Indirect Inguinal Hernia due to an Inflamed Appendix (Amyand’s Hernia) is a very rare finding indeed and warrants reporting. The incidence of a normal appendix within an inguinal hernial sac is estimated to be approximately 1%, whereas acute appendicitis presented in an inguinal hernia is a very rare event (0.1% of all cases of appendicitis) 1-5 Amyand’s Hernia is named after Claudius Amyand (1680-1740), who was the first one to perform the first recorded successful appendectomy on an 11-year old boy with a perforated appendix within an inguinal hernial sac in 1735[1]. Of course the clinical presentation varies, depending on the extent of the inflammatory process in the hernial sac and the presence or absence of peritoneal contamination due to perforation. In our case, it is a 4 year old male child patient, who was presented to the surgical department of the University of Science & Technology Hospital, Sana’a, Yemen, on February 27th 2007, with a right scrotal swelling, which was tender to touch. The child had been crying with abdominal pain during the night and had had two attacks of vomiting. His mother also stated that her child had had a right scrotal swelling since birth. The case was diagnosed as an Incarcerated Congenital Right Indirect Inguinal Hernia. During surgery it was discovered to be an Amyand’s Hernia (Inflamed appendix in the inguinal hernial sac). A classical appendectomy and herniotomy was performed. The child was discharged home in good health on the second post operative day, to return for the removal of the stitches on the seventh postoperative day, with uneventful postoperative course.
Method: A 4 year old male child patient was presented at our Surgical Department in the University of Science & Technology Hospital, Sana’a, Yemen, on February 27th 2007, with a right scrotal swelling tender to touch. The mother stated that the child had been crying since the previous night and would not allow her to touch his lower abdomen or genitalia. He had vomited twice since the early morning and was feverish. She admitted that he had had right reducible scrotal swelling since birth. A clinical diagnosis of Incarcerated Right Congenital Indirect Inguinal Hernia was set. The family was informed about the diagnosis and the need for an urgent surgical operation to be performed. Formal consent for the performing of surgery and the use of photographs for academic purposes was obtained from the family. Laboratory tests done included a FBC and a General urine examination. The results were all within normal limits except for mild leucocytosis (WBC: 11300mm3). The operation was performed through a right inguinal incision.
Result: Right Indirect Inguinoscrotal Hernia; when the hernial sac was opened, an inflamed appendix was revealed inside.
Conclusion: When performing surgery we have to expect the unexpected. This also applies in paediatric cases of congenital indirect inguinal hernias, especially when the hernia is large or one of a scrotal type; it is better to operate on such cases without delay to decrease the risk of morbidity and mortality.
