Asian Journal of Case Reports in Surgery

Background: Amyand’s hernia (AH) is a rare form of inguinal hernia in which the vermiform appendix is present within the hernia sac. It may be associated with a normal, inflamed, or perforated appendix, and preoperative diagnosis is often difficult because the clinical presentation frequently resembles an incarcerated or strangulated inguinal hernia. The lack of consensus on issues such as appendicectomy for a normal appendix, use of mesh after appendicectomy, and open versus laparoscopic approaches highlights the importance of AH.

Case Presentation: An 8-year-old male child presented with a one-month history of reducible right groin swelling that became painful and irreducible over three days. Clinical examination revealed a tender, irreducible right inguinoscrotal swelling with overlying erythema, increased local temperature, and absent cough impulse. The patient was afebrile and haemodynamically stable, and laboratory investigations were within normal limits. A clinical diagnosis of incarcerated right inguinal hernia was made, and emergency surgical exploration was performed under general anaesthesia. Intraoperatively, the vermiform appendix was found within the hernia sac, confirming AH. The appendix was oedematous, hyperaemic, and inflamed, without perforation or abscess formation. Appendicectomy was performed through the hernia sac, followed by high ligation of the sac and herniotomy. Mesh repair was avoided because the patient had type II AH according to the Losanoff and Basson classification. The postoperative recovery was uneventful. At 6-month follow-up, the patient was asymptomatic without features of recurrence.

Conclusion: AH should be considered in children presenting with incarcerated right inguinal hernia. Early surgical exploration, recognition of intraoperative findings, and an individualised approach to hernia repair are important for optimal management and a favourable outcome.