Amyand's hernia containing appendiceal neuroma presenting as incarcerated inguinal hernia: A rare case report from Ethiopia

Abstract

INTRODUCTION AND IMPORTANCE: Amyand's hernia is a rare type of inguinal hernia which involves either a normal or diseased appendix within the hernia sac. We report an extremely rare case of appendiceal neuroma, presenting as an incarcerated Amyand's hernia. CASE PRESENTATION: A 55-year-old male patient presented in the emergency department due to a persistent right inguinal painful swelling. Clinical examination revealed a 5 cm × 3 cm firm and irreducible right groin mass. A diagnosis of an incarcerated right inguinal hernia was made, and the patient was prepared for surgery. Intraoperatively, a 5 cm × 3 cm firm mass originating from the distal part of the appendix was found in the hernia sac. An appendectomy and a modified Bassini hernia repair were done. The result of the histological examination revealed appendiceal neuroma, and no further surgical intervention was needed. DISCUSSION: Amyand's hernia encompasses various pathological features, including a normal, inflamed, or perforated appendix, and rarely appendiceal tumors. In the literature, we found about eight cases of malignant appendiceal tumors reported. Most of the cases indicate that the treatment of Amyand's hernia containing appendiceal tumors was an appendectomy alone, while one report with adenocarcinoma required a right hemicolectomy after biopsy result. Notably, there are no documented cases of appendiceal neuromas presenting as inguinal hernias in our search of English literature using Google Scholar and PubMed search engines. CONCLUSION: Amyand's hernia-containing appendiceal neuroma is an extremely rare entity. It is important to do histopathologic study to differentiate appendiceal neuroma from malignant tumors. In case of Amyand's hernia with appendiceal neuroma, simple appendectomy with hernia repair is adequate treatment.