Incidental discovery of Amyand's hernia

A 58-year-old woman was referred to Hospital Tuanku Ja’afar (Seremban, Malaysia) for contrast-enhanced CT abdomen and pelvis following discovery of a solid mass in the right adnexa on ultrasonography. The pathophysiology is unclear but the vermiform appendix is thought to herniate through a patent processus vaginalis.1 It is a rare type of hernia occurring in 0.4%–1% of inguinal hernias and most often in male patients.1 2 Symptomatic patients usually present with signs and symptoms indistinguishable from an incarcerated inguinal hernia. [...]the condition is often diagnosed by imaging or intraoperatively. Some suggest appendectomy for all left-sided Amyand’s hernia while others are in favour of appendectomy only if it is inflamed.3 Losanoff and Basson proposed a classification system for staging and management of Amyand’s hernia—all involving hernia repair.3 Reduction and mesh repair are only recommended for normal appendix while appendectomy and repair of a hernia without using mesh are recommended if there is any evidence of appendicitis (stages 2–4).1 Mesh is thought to increase the chance of wound infection, sepsis and fistula formation.1 Learning points Amyand’s hernia is a rare type of hernia occurring in 0.4%–1% of inguinal hernias.