Amyand's hernia: Cause of inguinal swelling

Amyand's hernia is a condition where the vermiform appendix is contained within an inguinal hernia sac. An inguinal hernia with an appendix in the hernia sac is extremely rare and almost exclusively occurs on the right side. The mechanism of developing appendicitis with hernia is most likely the compression of the appendix at the level of the neck of the sac or due to impaired vascular supply leading to infection. Despite technological advances in radiology modalities, the preoperative diagnosis of and hernia is challenging: the role of abdominal ultrasound and computed tomography is very important and is essential in planning surgical management and approaches. In our case, we made a rare preoperative diagnosis of Amyand's hernia using ultrasound showing a typical appearance only without wall hyperemia probably due to vascular compression of the inguinal ring, which was confirmed by CT. CT is more sensitive to the detection of radiological signs of appendiceal inflammation and perforation in the hernia sac and is most often used in the case of an inconclusive ultrasound findings. Due to the prompt radiological diagnosis of acute appendicitis in the hernia sac provided by ultrasound, our patient underwent laparoscopic appendectomy.