MTP1.13 Laparoscopic mesh repair of Amyand's hernia, a case report

Introduction Amyand’s hernia is a rare type of hernia in which the appendix is located within an inguinal hernia sac. It is typically diagnosed incidentally during surgery, and its repair poses challenges due to its rarity, occurring in approximately 1% of all inguinal hernias. Case Report A 68-year-old female presented with a one-day history of generalized abdominal pain, nausea, and vomiting. On examination, there was tenderness in the lower abdomen and a palpable, tender lump in the right groin. A CT scan revealed a right-sided groin hernia, likely femoral, with protrusion of a short segment of the distal ileum and upstream small bowel dilatation [Fig. 1]. The patient underwent laparoscopic surgery, which identified an inflamed, elongated appendix incarcerated at the internal ring [Fig. 2]. Additionally, the distal ileum's antimesenteric border appeared contused but had spontaneously reduced. A laparoscopic appendicectomy was performed, followed by transabdominal preperitoneal (TAPP) repair of the inguinal hernia using a polyester mesh. The postoperative course was uneventful, and the patient was discharged the next day with a five-day course of antibiotics. Discussion Amyand’s hernia is a rare entity and challenging to diagnose preoperatively. Several case reports have demonstrated satisfactory outcomes when appendicectomy is performed in conjunction with mesh repair of the inguinal hernia. Current evidence suggests that mesh repair is feasible in the absence of sepsis. Conclusion Laparoscopic appendicectomy and mesh repair of an inguinal hernia appear to be safe and effective for treating Amyand’s hernia in the absence of sepsis.