About Three Cases across the Clinical Spectrum of Amyand’s Hernia: Diagnostic and Surgical Management Strategies

Abstract

Background: Amyand’s hernia (AH) is defined by the presence of the vermiform appendix within an inguinal hernial sac. Its incidence is approximately 1% of all inguinal hernias, whereas the complicated form—involving acute appendicitis, perforation, or abscess formation—occurs in only 0.07–0.13% of cases. Preoperative diagnosis is uncommon, and the optimal surgical strategy depends on the inflammatory status of the appendix, as codified by the Losanoff–Basson classification. Case Presentation: We report three consecutive cases managed at the Department of Visceral Surgery, Military Teaching Hospital Mohammed V, Rabat, Morocco. Case 1 involved a 78-year-old woman with a 48-hour history of bowel obstruction secondary to an irreducible right inguinal hernia. Computed tomography did not identify the appendix within the sac; however, a perforated, abscessed appendix was discovered intraoperatively (Losanoff–Basson Type 3). Appendicectomy, evacuation of pus, omentectomy, and primary suture herniorrhaphy without mesh were performed. Case 2 involved a 45-year-old man with acute right inguinal pain and inflammatory signs. No imaging was obtained, and an acutely inflamed appendix was found within an indirect inguinal hernia (Type 2); appendicectomy and Bassini repair were performed. Case 3 involved a 50-year-old man with an elective, reducible right inguinal hernia. A normal, non-inflamed appendix was found within the sac (Type 1); the appendix was preserved, and a Lichtenstein tension-free mesh repair was performed. All three patients remained recurrence-free at three years of follow-up. Conclusion: Amyand’s hernia spans a broad clinical spectrum. The Losanoff–Basson classification provides a practical framework for surgical decision-making by guiding appendicectomy, avoidance of mesh in infected fields, and preservation of the appendix in elective, non-inflamed cases. Individualised management was associated with recurrence-free outcomes in all three patients at three years of follow-up.