A rare case of an intra-scrotal Amyand’s hernia

Abstract

BACKGROUND: Amyand’s hernias are rare forms of inguinal hernias in which the appendix is contained within the hernia, being present in a minority of hernias. Clinical diagnosis is difficult, with most cases being found intra-operatively as ultrasound is rarely performed beforehand.

CASE REPORT: A 1-month-old premature male infant was referred to our emergency services with a right-sided inguinal mass suspected to be an inguino-scrotal hernia. The mass was clinically non-tender and non-inflamed. An ultrasound exam of the right inguinal mass was performed, revealing a non-inflamed appendix alongside a normal appearing testicle, with a small amount of hydrocele. Surgical intervention was subsequently undertaken to address the hernia.

DISCUSSION: Amyand's hernia presents a unique challenge in diagnosis and management. Our patient's case corresponded to Amyand's hernia type 1 and stage 3, as per the Losanoff and Basson classification, where the appendix is non-inflamed and has descended to the scrotum. This pathology is exceedingly rare, with the appendix being found in approximately 1% of inguinal hernias, predominantly in males. The pathogenesis is not fully understood but is attributed to fibrous connections and a patent process vaginalis. The diagnosis is often made intra-operatively due to the variable clinical presentation.

CONCLUSION: We present a rare case 1-month-old premature boy, who presented with a right inguinal mass. Ultrasound revealed an intrascrotal type 1, stage 3 Amyands’s hernia.