Amyand's hernia: a rare inguinal hernia
A 61-year-old African-American male was seen in the surgery clinic with a 6-year history of an umbilical and enlarging right inguinal hernia. The umbilical hernia was symptomatic causing intermittent discomfort. The right inguinal hernia was also symptomatic and had progressively enlarged over time. He denied any changes in bowel habits or history of intestinal obstruction.\nOn physical examination, his abdomen was soft, non-tender and non-distended. A small supra-umbilical tender bulge was present and incarcerated. An inguinal examination was significant for a right-sided, tender, reducible mass without scrotal involvement.\nOn the day of surgery, the patient was prepped, and draped in an aseptic technique. Initially, the umbilical hernia was repaired primarily without complication. The right inguinal hernia repair was approached with a 5 cm right-sided oblique incision parallel to the inguinal ligament. Subcutaneous tissue through Scarpa's fascia was divided until aponeurotic fibers of the external oblique were visualized. After dividing the external oblique to the superficial inguinal ring, the contents of the inguinal canal were then circumscribed using blunt dissection. The hernia sac lateral to the inferior epigastric pedicle was dissected away from the spermatic cord to the deep inguinal ring. The sac was opened illustrating the cecum and vermiform appendix (Fig. ). There were no inflammatory changes of the appendix or cecum. The sac contents were reduced into the peritoneal cavity. The hernia sac was excised and the peritoneum was suture ligated. We performed a tension-free polypropylene mesh repair. The patient was discharged the same day. He returned to clinic 1 month later with no complications and no recurrence of his hernias.