Introduction:
Amyand's hernia is an inguinal hernia containing the caecal appendix. It is usually an intraoperative finding, although it can be diagnosed preoperatively with radiologic examinations, which would show a tubular structure inside the inguinal canal.
Presentation of case:
A male patient presented to the emergency department complaining of abdominal pain in the right lower quadrant. He had been orchidectomized during his childhood due to cryptorchidism, and had been under antibiotic treatment a week before due to a suspected gonorrhoea. A small irreductible mass was found in the right groin. Blood tests showed leucocytosis and elevated CRP. A CT-scan was performed, reporting a tubular structure with a blind end entering the inguinal canal that seemed to be the appendix. Single-port laparoscopic exploration was indicated, and a right vasitis was found instead of an Amyand's hernia. After the operation, the patient explained that he had not taken the antibiotics for the gonorrhoea.
Discussion:
Untreated gonorrhoea causes ascendant vasitis and orchyepididimitis. In the present case, since the patient did not have testicles, the inflamed vas deferens mimicked the Appendix inside the inguinal canal. If the patient had told the truth about the untreated gonorrhoea, maybe the condition would have been suspected and no radiological examinations would have been performed, which subsequently lead to an unnecessary operation.
Conclusion:
Presently, Amyand's hernia is more frequently diagnosed preoperatively than intraoperatively. However when an Amyand's hernia is preoperatively suspected, the possibility of a vasitis should always be ruled out in order to avoid unnecessary operations.