PDF(Pubmed)
Abstract：
BACKGROUND: Amyand\'s hernia (AH) is an appendix (with or without acute inflammation) trapped within an inguinal hernia. Most AH with acute appendicitis had a preexisting appendix within the hernia sac. We herein report a variant of AH that has never been described before. An inflamed appendix that was managed conservatively was found to have migrated and trapped in the sac of a previously unrecognized right inguinal hernia 6 weeks after the index admission, resulting in a secondary Amyand\'s hernia.
METHODS: A 25-year-old healthy Taiwanese woman had persistent right lower abdominal pain for 1 week and was diagnosed with perforated appendicitis with a localized abscess by abdominal computed tomography (CT). No inguinal hernia was noted at that time. Although the inflamed appendix along with the abscess was deeply surrounded by bowel loops so that percutaneous drainage was not feasible, it was treated successfully with antibiotics. However, she was rehospitalized 6 weeks later for having a painful right inguinal bulging mass for a week. Abdominal CT revealed an inflamed appendix with abscess formation in an indirect inguinal hernia raising the question of a Amyand\'s hernia with a perforated appendicitis. Via a typical inguinal herniorrhaphy incision, surgical exploration confirmed the diagnosis, and it was managed by opening the hernial sac to drain the abscess and reducing the appendix into the peritoneal cavity, followed by conventional tissue-based herniorrhaphy and a laparoscopic appendectomy. She was then discharged uneventfully and remained well for 11 months.
CONCLUSIONS: Unlike the traditional definition of Amyand\'s hernia, where the appendix is initially in the hernia sac, the current case demonstrated that Amyand\'s hernia could be a type of delayed presentation following initial medical treatment of acute appendicitis. However, it can still be managed successfully by a conventional tissue-based herniorrhaphy followed by laparoscopic appendectomy.
METHODS: A 25-year-old healthy Taiwanese woman had persistent right lower abdominal pain for 1 week and was diagnosed with perforated appendicitis with a localized abscess by abdominal computed tomography (CT). No inguinal hernia was noted at that time. Although the inflamed appendix along with the abscess was deeply surrounded by bowel loops so that percutaneous drainage was not feasible, it was treated successfully with antibiotics. However, she was rehospitalized 6 weeks later for having a painful right inguinal bulging mass for a week. Abdominal CT revealed an inflamed appendix with abscess formation in an indirect inguinal hernia raising the question of a Amyand\'s hernia with a perforated appendicitis. Via a typical inguinal herniorrhaphy incision, surgical exploration confirmed the diagnosis, and it was managed by opening the hernial sac to drain the abscess and reducing the appendix into the peritoneal cavity, followed by conventional tissue-based herniorrhaphy and a laparoscopic appendectomy. She was then discharged uneventfully and remained well for 11 months.
CONCLUSIONS: Unlike the traditional definition of Amyand\'s hernia, where the appendix is initially in the hernia sac, the current case demonstrated that Amyand\'s hernia could be a type of delayed presentation following initial medical treatment of acute appendicitis. However, it can still be managed successfully by a conventional tissue-based herniorrhaphy followed by laparoscopic appendectomy.
摘要：
背景：Amyand\'s疝（AH）是被困在腹股沟疝中的阑尾（有或没有急性炎症）。大多数患有急性阑尾炎的AH在疝囊内预先存在阑尾。我们在此报告了以前从未描述过的AH变体。经保守治疗的发炎阑尾在入院后6周被发现迁移并被困在先前未被识别的右腹股沟疝的囊中。导致继发性Amyand\'s疝气。
方法：一名25岁的健康台湾女性持续右下腹疼痛1周，腹部计算机断层扫描（CT）诊断为穿孔性阑尾炎伴局部脓肿。当时没有发现腹股沟疝。尽管发炎的阑尾和脓肿被肠环深深包围，所以经皮引流是不可行的，用抗生素成功治疗。然而,6周后，她因右侧腹股沟隆起性肿块疼痛一周而再次住院。腹部CT显示阑尾发炎并在腹股沟斜疝中形成脓肿，这引起了Amyand\'s疝伴穿孔性阑尾炎的问题。通过典型的腹股沟疝修补术切口，手术探查证实了诊断，它是通过打开疝囊引流脓肿并减少阑尾进入腹膜腔来管理的，随后是传统的基于组织的疝修补术和腹腔镜阑尾切除术。随后，她顺利出院，并保持了11个月的健康。
结论：与传统的Amyand疝气定义不同，阑尾最初在疝气囊中，目前的病例表明，Amyand's疝可能是急性阑尾炎初始药物治疗后的一种延迟表现。然而,传统的基于组织的疝修补术后腹腔镜阑尾切除术仍可成功治疗.
方法：一名25岁的健康台湾女性持续右下腹疼痛1周，腹部计算机断层扫描（CT）诊断为穿孔性阑尾炎伴局部脓肿。当时没有发现腹股沟疝。尽管发炎的阑尾和脓肿被肠环深深包围，所以经皮引流是不可行的，用抗生素成功治疗。然而,6周后，她因右侧腹股沟隆起性肿块疼痛一周而再次住院。腹部CT显示阑尾发炎并在腹股沟斜疝中形成脓肿，这引起了Amyand\'s疝伴穿孔性阑尾炎的问题。通过典型的腹股沟疝修补术切口，手术探查证实了诊断，它是通过打开疝囊引流脓肿并减少阑尾进入腹膜腔来管理的，随后是传统的基于组织的疝修补术和腹腔镜阑尾切除术。随后，她顺利出院，并保持了11个月的健康。
结论：与传统的Amyand疝气定义不同，阑尾最初在疝气囊中，目前的病例表明，Amyand's疝可能是急性阑尾炎初始药物治疗后的一种延迟表现。然而,传统的基于组织的疝修补术后腹腔镜阑尾切除术仍可成功治疗.
