A Case of Pediatric Amyand’s Hernia Simulating Epididymitis and Diagnosed Preoperatively by Computed Tomography

Abstract

Amyand’s hernia is a rare inguinal hernia containing the appendix vermiformis, which is difficult to diagnose preoperatively. We report a case of Amyand’s hernia, which is difficult to distinguish from epididymitis, diagnosed preoperatively by Computed Tomography. A 1-year-3-month-old boy was brought to our hospital presenting with distension of the right groin, redness, and swelling of the right scrotum. We diagnosed him as having epididymitis and started conservative treatment with oral antibiotics, but there was no improvement in the patient’s condition. On the 6th day of illness, to investigate the funicular structure that we found in the inguinal canal by ultrasonography, we carried out CT and diagnosed him as having Amyand’s hernia with appendicitis. We performed appendectomy and inguinal hernia repair by the inguinal approach, and we successfully kept the intraperitoneal space free from infection. Although a review of the echography images obtained earlier showed an incarcerated appendix vermiformis in the inguinal canal as a narrow funicular structure, we considered that echography was insufficient for the diagnosis of Amyand’s hernia at the first medical examination and CT was needed for preoperative diagnosis. The inguinal approach was effective in preventing the spread of infection inside the abdomen.