Intraoperative diagnosis of Amyand's hernia: inguinal herniorrhaphy, appendicectomy and orchidectomy.

Abstract

Amyand's hernia, a rare condition where the appendix is contained within an inguinal hernia sac, occurs in ~1% of inguinal hernias, with <0.1% involving acute appendicitis. Though often diagnosed intraoperatively, imaging advancements like CT and ultrasound have improved preoperative detection. We present a case of a male in his 70s with a right-sided direct inguinal hernia, diagnosed via ultrasound. Intraoperatively, a non-inflamed appendix was found in the hernial sac. Despite the absence of appendicitis, an appendectomy was performed due to age, comorbidities and potential future risk. Hernia repair was completed using ProGrip self-fixating mesh and the Bassini technique. Postoperative recovery was uneventful, with mild discomfort and no wound complications. This case underscores the ongoing debate regarding prophylactic appendectomy in non-inflamed Amyand's hernias and supports mesh repair when inflammation is absent. Individualised surgical decisions based on patient-specific risk factors remain key in managing this rare condition.