Should an Appendectomy Be Performed for the Treatment of Amyand's Hernia with Non-Inflamed Vermiform Appendix? A Case Report and Review of the Literature

Background: Presence of vermiform appendix in an inguinal hernia, whether inflamed or not, is called Amyand's hernia. We present a case that was operated on for Amyand's hernia and discuss whether or not an appendectomy should be performed in such a patient, even in the case of a non-inflamed appendix. Case Report: We report a case of Amyand's hernia with non-inflamed appendix, adhering to the inguinal sac wall. A 36-year-old man who was scheduled for elective surgery was referred to our hospital for a large right-side inguinal hernia. During the operation, the appendix was found within the indirect sliding hernia sac. The appendix was non-inflamed and adhered to the inguinal sac wall. The appendix and cecum were freed from adhesions to the sac. Then, appendectomy was performed. The hernioplasty was carried out with synthetic mesh. The postoperative course of the patient was uneventful while pathological examination revealed a normal appendix with lymphoid hyperplasia. The patient had no problems on the postoperative follow-ups after 3 and 6 months. Conclusions: The treatment approach of Amyand's hernia depends on the inflammatory state of the appendix. If the appendix is inflamed, appendectomy is mandatory. If the appendix is normal, appendectomy is controversial. Although there is a general consensus by most authors that a normal appendix in the hernia sac does not require appendectomy because of the risk of infectious complications, it is important to be aware of all clinical settings. The decision to perform an appendectomy and/or to use the mesh technique should always be individualized to the patient.