Amyand´s hernia associated with Richter´s hernia evolving with acute appendicitis: case report

Abstract

Introduction: The presence of vermiform appendix inside the hernia sac is infrequent. In the literature, the reported incidence is of about 1% of all hernias. The finding of acute appendicitis in the inguinal hernia is even rarer, clinical picture that is called Amyand´s hernia. Another possible situation is the Richter´s hernia, where part of the circumference of the intestine is trapped and strangled in the hernia hole, leading to ischemia, gangrene and visceral perforation. We report a case presented at the Hospital Regional do Cariri in Juazeiro do Norte-Ceará, of Amyand´s hernia associated with Richter´s hernia in the same hernia sac, nosological entity of rare occurrence, followed by review of the available literature about the topic. Method: The research was conducted on PubMed using the uniterms "Amyand´s hernia" and "Richter´s hernia" then the most relevant publications about the topic were filtered and correlated with the findings of the case reported. Discussion: In this type of inguinal hernia, the hernia content is constituted by the vermiform appendix concomitant to the antimesenteric pinched edge of the ileal loop. There was still the incidental finding of a Meckel's diverticulum. The patient had a clinical diagnosis of incarcerated hernia and was submitted to surgical treatment with the finding of Amyand´s hernia associated with Richter´s hernia, evolving satisfactorily in the postoperative.