Abstract
A 76-year-old man was seen at the hospital because of a few-day history of epigastralgia, fever, and vomiting. Physical examinations when he was first seen revealed an about 25-cm diameter tumor with tenderness from the right inguinal region to the right scrotum. The abdomen was mildly distended and there was mild tenderness at the epigastric region, but no peritoneal signs were noted. Abdominal CT scan showed a huge right inguinal hernia containing a small intestine and adipose tissue in the hernia sac, as well as dilatation of the small intestine in the abdominal cavity. Right inguinal hernia in which the small intestine had incarcerated was diagnosed and emergency operation was carried out. When surgery was initiated through an inguinal approach, incision of the hernia sac resulted in projectile defluxion of purulent ascites. The hernia sac was clarified to contain large quantities of greater omentum, an 80-cm portion of the small intestine, part of the cecum, and the remarkably inflamed appendix which had perforated. Appendectomy was performed outside of the surgical wound, followed by iliopubic tract repair. The patient's postoperative course was uneventful and he was discharged from the hospital on the 9th postoperative day.
Amyand's hernia containing the appendix in the hernia sac is a rare entity. We herein present our case and 34 cases reported so far in Japan, together with some bibliographic comments.
