# Strangulated Inguinal Hernia Containing Caecum and Inflamed Appendix: Two Case Reports and Review of the Literature to Guide Management

## TL;DR

This paper presents two cases of a rare hernia containing the appendix and caecum, and reviews treatment strategies to guide surgical management.

## Contribution

The paper contributes two new case reports and a literature review to inform the surgical management of Amyand’s hernia.

## Key findings

- Both patients had inflamed appendix and caecum in the hernia sac without necrosis.
- Appendectomy with infection prevention and Lichtenstein repair led to good outcomes in both cases.
- Systematic exploration of the hernia sac is crucial for diagnosing Amyand’s hernia.

## Abstract

Amyand’s hernia is defined by the presence of the appendix in the sac of an inguinal hernia. Its treatment poses two problems: the risk of infection associated with the presence of the appendix and the choice of surgical technique, which must reduce the risk of infection while minimising the risk of recurrence. In this article, we present two patients treated for a strangulated inguinal hernia containing the appendix and caecum and review the literature for evidence that may guide the choice of treatment.

We present two male patients, aged 37 and 44, admitted to our department for a strangulated right inguinal hernia. During surgical exploration, the hernia sacs of both patients contained the appendix and caecum, which were inflamed without necrosis. Both patients underwent appendectomy with protection of the surgical site and instillation of povidone-iodine into the surgical site to reduce the risk of infection. Both were treated using the Lichtenstein procedure. The postoperative course was uneventful in one patient, while the other had oedema of the cord, which responded well to enzymatic anti-inflammatory treatment made of on trypsin, pancreatic ribonuclease and chymotrypsinogen. Examination of the surgical specimens confirmed appendicitis.

Most Amyand hernias are diagnosed during the treatment of a complicated hernia. There are no specific signs, hence the importance of systematically opening the hernia sac when treating a complicated hernia. During surgery, the surgeon must choose an appropriate technique based on the risk of infection and perform a routine appendectomy, followed by an examination of the surgical specimen. The role of hernioplasty according to the Desarda procedure could be evaluated for this indication. The Losanoff-Basson classification should be constantly updated as treatment procedures and available resources evolve.