Gangrenous appendicitis in Amyand's hernia: Surgical approach under local anesthesia. Case report and review of the literature.

Caruso, Giovambattista; Toscano, Chiara; Evola, Giuseppe; Benfatto, Salvatore Antonio Maria; Reina, Martina; Reina, Giuseppe Angelo

INTRODUCTION AND IMPORTANCE Amyand hernia is a rare disease seen in approximatively 1% of all hernias, complications of it, like acute appendicitis, or perforated appendicitis are even more rare, about 0.1%. Its diagnosis is very difficult in the preoperative period: it is usually an incidental finding. CASE PRESENTATION We report an unusual case of perforated gangrenous appendicitis with peri-appendicular abscess occurring in an irreducible Amyand's hernia. An 80-year-old male, with chronic obstructive disease and pulmonary emphysema, atrial fibrillation, acute myocardial infarction, underwent urgent surgery, under local anesthesia, for right incarcerated inguinoscrotal hernia. He was found to have a perforated gangrenous appendicitis with peri-appendicular abscess within a right indirect inguinal hernia sac. Appendicectomy and Bassini's hernia repair were performed under local anesthesia without any complications. CLINICAL DISCUSSION The treatment of Amyand's hernia is not standardized. The current generally accepted algorithm for Amyand's hernia is essentially contingent on the appendix's condition within the hernia sac. CONCLUSION Appendectomy and primary herniorrhaphy, under local anesthesia, for type 3 of Amyand's hernia, is a safe procedure and easy to perform and, if confirmed by further study, could be part of every surgeon's knowledge.