Endoscopic removal of foreign body abandoned in prior laparotomy.

The appendix is found in the hernial sac in around 1% of inguinal hernias and an inflamed appendix is found in only 0.13% of cases. A variant of this, an appendix inside a femoral hernia, is called a Garengeot hernia 4. In 1937, Ryan described 11 cases of acute appendicitis (within an inguinal hernia) among 8,692 cases of appendicitis 12. Another author 1 reported 10 cases of appendicitis within an inguinal hernia over nine consecutive years. The etiopathogenesis of acute appendicitis is unclear. Many authors believe there is an association between incarceration and inflammation of the cecal appendix in the hernial sac, that is, an ischemic phenomenon deriving from compression of the organ by the hernial ring leading to appendicitis 14. Typical symptoms of acute appendicitis, such as initial epigastric pain settling later in the right iliac fossa, nausea, vomiting and anorexia may also be seen in patients with an Amyand hernia. According to the literature, fever and leukocytosis are not common in these patients 13. Pre-operative diagnosis is unusual. In an article reviewing 50 cases of Amyand's hernia, only one case was diagnosed prior to surgery 14. The presence of peritoneal irritation and early pain in an incarcerated hernia may suggest appendicitis inside the hernial sac. The use of imaging methods may assist diagnosis 4. Surgery is mandatory. However, the kind of surgery recommended subject to controversy. In most circumstances, treatment involves an emergency appendectomy and repair of the hernia 8. When there is a risk of complications, such as a pericecal abscess, the appendectomy should be pre-peritoneal to minimize possible infection of the wound and recurrence of the hernia 2. Amyand's hernia: a case report of an incarcerated and perforated appendix within an inguinal hernia and review of the literature. Am Surg 2001; 67(7)628-9. 9. Losanoff JE, Basson MD. Amyand hernia: what lies beneath-a proposed classification scheme to determine management.