Resumen

VILLARREAL, Ricardo; LUNA JASPE, Carlos; CABRERA, Luis Felipe  y  VINCK, Eric. Incarcerated Amyand's hernia, literature review and report of a case at a tertiary level of care institution in Bogotá, Colombia. rev. colomb. cir. [online]. 2016, vol.31, n.4, pp.283-288. ISSN 2011-7582.

Introduction: Amyand's hernia is an inguinal hernia that contains a normal or an inflamed vermiform appendix. Claudius Amyand first described it in 1735. When acute appendicitis is present, it is believed to be due to extra-luminal obstruction generated by the inguinal ring pressure limiting blood flow, in contrast to the increased intra-luminal pressure that occurs in the acute appendicitis not associated with hernias. This process results in inflammation, bacterial overgrowth, and the appendix becomes more vulnerable to trauma. Methods and Results: We describe and analyze the surgical management of a clinical case of an Amyand's hernia, managed by the Department of General Surgery of a third level of care institution in Bogotá, Colombia; a literature review was carried out. Despite the availability of the surgical guideline proposed by Losanoff and Basson for the management of the Amyand's hernia, our surgical approach deviated from this guideline, with both surgical and postoperative success. Discussion: Amyand's hernia is a rare surgical finding, representing both a diagnostic and a surgical challenge, for it presents with characteristics that vary due to the presence of two simultaneous pathologies: the inguinal hernia and the acute appendicitis if present. The surgical approach depends on the intraoperative findings, such as perforation, fistulas or peritonitis. Therefore, deciding on the best surgical approach depends on the surgical findings and the surgeon's preference. Conclusions: The management of the Amyand's hernia with appendectomy and/or primary hernia repair with mesh, has been topic of discussion among surgeons for years. This difference in opinion on which surgical approach is the most appropriate, in part is due to the low incidence and rarity of this entity and the surgeon's preference; thus, the best surgical technique is still matter of debate. However, appendectomy is contraindicated in certain patients when there is no inflammation, and when it is present, the use of mesh is still controversial. For this reason each report of Amyand's hernia and its treatment becomes important, for it provides knowledge in order to choose the most appropriate surgical technique for this rare entity.

Palabras clave : hernia; inguinal; Amyand's hernia; appendix; appendicitis; appendectomy; diagnosis.

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