- Jessmine Anntinea 1
- Najua Ramli 2
- Muthu V
- [email protected], Hospital Sultanah Aminah, Johor
- Hospital Sultanah Aminah, Johor
Less than 1% of all inguinal hernia cases are Amyand Hernia and from this, only 0.13% have inflamed appendix. Few opinions have been postulated regarding mechanism of appendicitis in inguinal canal. Amyand’s hernia is most often diagnosed intra-operatively since the presenting symptoms can be similar to testicular torsion or inflammation even with ultrasonography.
A 3 month old boy, who was known to have reducible right inguinal hernia, was admitted to a district hospital for right scrotal swelling for 3 days associated with reduced oral intake. His upper scrotum was noted to be erythematous on physical examination. Child was referred and transferred to a Paediatric Surgical unit. Upon arrival to Paediatric Surgery Unit, erythema was noted to have spread to contralateral hemiscrotum and upwards to right lower abdomen. Abdominal radiograph did not show dilated bowel or gas in hemiscrotum. Patient was subjected to right herniotomy and findings were consistent with perforated appendix. Appendectomy was done through herniotomy incision. Patient was observed in Intensive Unit post-operatively for fear of sepsis but he recovered uneventfully.
Diagnosis of Amyand’s hernia is almost always intra-operative but expanding erythema should raise suspicion of this diagnosis – prompting more aggressive resuscitation and post-operative observation.