The role of prophylactic appendectomy in amyand’s hernia with non-inflamed appendix in the elderly: A case report

The role of prophylactic appendectomy in amyand’s hernia with non-inflamed appendix in the elderly: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report The role of prophylactic appendectomy in amyand’s hernia with non-inflamed appendix in the elderly: A case report Laureen Celcilia, Ishak Lewi Ndaumanu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7789897/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Amyand’s hernia is defined as an inguinal hernia in which a portion of the appendix is found within the hernia sac. The aim of this report is to present a successfully treated case of Amyand’s hernia and to highlight the diagnostic challenges and appropriate surgical considerations. Case Presentation: We present a rare case of a 72-year-old male patient with a 6-year history of enlarging right inguinal hernia. An inguinal examination was remarkable for a right-sided, tender, reducible mass with scrotal involvement. Intraoperatively, the hernia sac was found to contain a non-inflamed appendix. Given the intraoperative findings, the surgical team proceeded with appendectomy followed by herniotomy and mesh repair. The postoperative course was uneventful and the patient was discharged two days after surgery. At follow-up, the patient remained well without evidence of recurrence or obstruction. Discussion: While the incidence of Amyand’s hernia is extremely rare (<1%), it can remain asymptomatic until appendiceal inflammation leads to life-threatening complications such as strangulation, necrosis, or perforation. Our patient had a Type 1 Amyand’s hernia, which typically does not require appendectomy. However, given the patient’s age, overall health status, and surgical risks, we opted for appendectomy to prevent future complications. Successful surgical intervention through appendectomy and hernioplasty emphasizes the importance of an individualized intraoperative approach. Conclusion: This case adds to the limited literature on surgical management of Amyand’s hernia and underscores the need for tailored management depending on the case. Further large-scale studies is needed to establish evidence-based, standardized protocols to ensure optimal outcomes. Figures Figure 1 Background The incidence of finding a normal appendix within the hernia sac is rare, occuring in less than 1% of inguinal hernia cases.[ 1 – 3 ] When complications appear such as inflammation, perforation, or strangulation, it becomes extremely uncommon, with an incidence of 0.1%.[ 4 ] This study presents a distinctive management approach for Amyand’s hernia. It highlights the absence of clear consensus for managing Amyand’s hernia anatomical variations. Case Presentation A 72-year old man presented with a 6-year history of swelling over his right inguinoscrotal area that had been progressively became larger. He mentioned that the swelling would worsen with exertion, such as straining or coughing but reduced when laying down. The discomfort began as intense, knife-like excruciating pain that eventually turned into localized tenderness. He did not seek any medical advice as it remained asymptomatic for six years. He denied any history of comorbidities, vomiting, nausea, fever, or trauma. There were no any issues with his urinary system and bowel habits. On physical examination, the patient’s vitals were stable. Groin examination revealed a soft, tender swelling in the groin extending into the right scrotum. The hernia was reducible and uncomplicated. There were no overlying skin changes, discharge, or bleeding observed during the examination. Bowel sounds were within normal limits. Pre-operative workup, including laboratory and chest X-ray was unremarkable. The patient was counseled regarding the need for surgical correction to repair the hernia. After discussing the risks and benefits with the patient, he agreed to proceed with surgery and was scheduled for an elective hernia repair. Under general anesthesia, a standard inguinal incision was made followed by dissection of the inguinal canal. Upon exploration of the hernia sac, it was revealed that a right indirect inguinal hernia contained both the appendix and the bowel (Fig. 1 ). No signs of inflammation or other abnormalities were found in the appendix. The appendectomy was performed successfully along with excision of the sac. Subsequently, the meshplasty procedure was completed without any complications, with the mesh securely placed over the inguinal canal to reinforce the weakened area. Finally, a sterile dressing was applied to the surgical site after the skin was closed. Postoperatively, the patient had a smooth recovery and was closely observed for any signs of infection or hernia recurrence. He received a 48-hour course of antibiotics and fluid therapy, oral fluids were administered after 6 hours along with soft diet. He was discharged from the hospital on post-operative day two with appropriate postoperative care instructions and scheduled for follow-up visits at the outpatient clinic. At follow up, the site of incision was healing well with no signs of infection. Discussion The current generally accepted treatment approach for Amyand’s hernia is fundamentally based on the condition of the appendix within the hernia sac. The Losanoff and Basson system provides a clear framework for surgeons to guide treatment decisions, depending on the degree of appendiceal inflammation (Table 1 ).[ 3 ] The first two categories in the Losanoff and Basson classification appear to be the most debated, especially category 2, which remains the most controversial.[ 5 ] In our case, the patient presented with a 6-year history of right inguinoscrotal swelling, eventually diagnosed intraoperatively as an Amyand’s hernia type 1. According to the Losanoff and Basson classification, mesh repair and hernia reduction should be done without removing the appendix.[ 3 ] Most authors agree that if the appendix is discovered incidentally without any signs of inflammation, prophylactic appendectomy is not required.[ 6 – 8 ] On the other hand, some prefer appendectomy in all Amyand’s hernia cases regardless of appendix’s condition. Those in favor of appendectomy argue that the appendix is susceptible to re-herniate and its removal helps to prevent recurrence, future appendicitis, or the need for additional surgery.[ 1 , 9 – 11 ] Conversely, others argue that appendectomy increases operative risk, potentially contaminating a previously sterile field and causing unnecessary infections.[ 6 – 8 ] In addition, dissection of the appendix base may result in a larger incision, weakening the tissue and increase the risk of recurrence.[ 12 ] Ultimately, the rationale behind treatment decision should consider the appendix condition, characteristics of hernia, the patient’s clinical conditions such as age, functional status, comorbidity, and life expectancy, and other circumstances not fully identified because of the limited research on this rare disease. Given our patient’s clinical profile and the presence of a non-inflamed appendix within the hernia, we opted for appendectomy during the surgery. The decision was made based on the patient’s age, general health status, and the potential risks associated with leaving the appendix intact. Furthermore, considering the need to minimize the risk of future herniation reccurence and mitigate the risk of postoperative infection, removal of the appendix was thought to be appropriate. Our decision to perform an appendectomy was further reinforced by Rikki et al. who suggests for appendectomy in all cases of Amyand’s hernia to ensure comprehensive treatment.[ 13 ] Additionally, Papaconstantinou et al. demonstrated a significantly high rate of appendectomy, even in the absence of appendiceal inflammation.[ 14 ] In support of our recommendation, Quartey et al. suggested appendectomy in the absence of inflamed appendix, as seen in their case report of an incarcerated recurrent Amyand’s hernia. In their study, the hernia was initially considered as Losanoff type 1, thus appendectomy was not performed, which later progressed into an incarcerated hernia.[ 15 ] Moreover, research has shown that emergency laparotomy or laparoscopy can result in morbidity and mortality rates up to 21% in patients above 65 years.[ 16 ] Table 1 Losanoff and Bason Classification [ 3 ] Classification Description Surgical management Type 1 Normal appendix within an inguinal hernia Hernia reduction, mesh repairs, appendectomy in young patients Type 2 Acute appendicitis within hernia, no abdominal sepsis Appendectomy through primary repair of hernia, no mesh Type 3 Acute appendicitis within an inguinal hernia, abdominal wall, or peritoneal sepsis Laparotomy, appendectomy, primary repair of hernia, no mesh Type 4 Acute appendicitis within an inguinal hernia, related or unrelated abdominal pathology Manage as type 1 to 3 hernia investigate or treat second condition as appropriate Conclusion This study on the repair of a type 1 Amyand’s hernia adds to the literature on surgical approaches for Amyand’s hernia. Despite being a single report with a favorable outcome, together with a handful of similar successful cases, it stands as a testament to the ongoing need for research into this rare condition. Without further research, surgical decisions may remain sub-optimal and unsupported by evidence, which could lead to higher rates of patient morbidity. More research will ultimately support surgeons in making informed decisions when dealing with this rare entity. Declarations Conflict of Interest The authors declare that they have no conflict of interest. Consent to Participate Informed consent was obtained from the patient. Consent to Publish The participant has consented to the submission of the case report to the journal. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. Author Contribution Authors contribution:1. L.C. wrote the original draft, prepared the included figures, and finalized the manuscript for submission.2. I.L.N. reviewed and edited the manuscript. Address of correspondence La Seine F11/50, Jakarta Garden City, Cakung, East Jakarta, Indonesia ORCID and Email of all authors Laureen Celcilia: https://orcid.org/0009-0002-1472-2568 and [email protected] Ishak Lewi Ndaumanu: [email protected] References Michalinos A, Moris D, Vernadakis S. Amyand’s hernia: a review. Am J Surg. 2014 June;207(6):989–95. Ivanschuk G, Cesmebasi A, Sorenson EP, Blaak C, Loukas M, Tubbs SR. Amyand’s hernia: a review. Med Sci Monit Int Med J Exp Clin Res. 2014;20:140–6. Losanoff JE, Basson MD. Amyand hernia: what lies beneath–a proposed classification scheme to determine management. Am Surg. 2007;73(12):1288–90. Patoulias D, Kalogirou M, Patoulias I. Amyand’s Hernia: an Up-to-Date Review of the Literature. Acta Medica (Hradec Kralove). 2017;60(3):131–4. Shaban Y, Elkbuli A, McKenney M, Boneva D. Amyand’s hernia: A case report and review of the literature. Int J Surg Case Rep. 2018;47:92–6. Okur MH, Karaçay S, Uygun I, Topçu K, Öztürk H. Amyand’s hernias in childhood (a report on 21 patients): a single-centre experience. Pediatr Surg Int. 2013 June;29(6):571–4. Sharma H, Gupta A, Shekhawat NS, Memon B, Memon MA. Amyand’s hernia: a report of 18 consecutive patients over a 15-year period. Hernia J Hernias Abdom Wall Surg. 2007;11(1):31–5. Cankorkmaz L, Ozer H, Guney C, Atalar MH, Arslan MS, Koyluoglu G. Amyand’s hernia in the children: a single center experience. Surgery. 2010;147(1):140–3. Sarici B, Akbulut S, Piskin T. Appendiceal Carcinoid Tumor within Amyand’s Hernia: A Case Report and Review of the Literature. Turk J Emerg Med. 2019;19(2):73–5. Priego P, Lobo E, Moreno I, Sánchez-Picot S, Gil Olarte MA, Alonso N, et al. Acute appendicitis in an incarcerated crural hernia: analysis of our experience. Rev Esp Enferm Dig. 2005;97(10):707–15. Gurer A, Ozdogan M, Ozlem N, Yildirim A, Kulacoglu H, Aydin R. Uncommon content in groin hernia sac. Hernia J Hernias Abdom Wall Surg. 2006;10(2):152–5. Psarras K, Lalountas M, Baltatzis M, Pavlidis E, Tsitlakidis A, Symeonidis N, et al. Amyand’s hernia-a vermiform appendix presenting in an inguinal hernia: a case series. J Med Case Rep. 2011 Sept;19:5:463. Patoulias D, Kalogirou M, Patoulias I. Amyand’s Hernia: an Up-to-Date Review of the Literature. Acta Medica (Hradec Kralove). 2017;60(3):131–4. Papaconstantinou D, Garoufalia Z, Kykalos S, Nastos C, Tsapralis D, Ioannidis O, et al. Implications of the presence of the vermiform appendix inside an inguinal hernia (Amyand’s hernia): a systematic review of the literature. Hernia J Hernias Abdom Wall Surg. 2020;24(5):951–9. Quartey B, Ugochukwu O, Kuehn R, Ospina K. Incarcerated recurrent Amyand’s hernia. J Emerg Trauma Shock. 2012;5(4):344–6. Tolstrup MB, Watt SK, Gögenur I. Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy. Langenbecks Arch Surg. 2017 June;402(4):615–23. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7789897","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":525266597,"identity":"01e81a43-66fd-421a-9525-6bfc6b0bec8d","order_by":0,"name":"Laureen 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09:17:08","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":41054,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7789897/v1/d4ae634bd143b9d7ae625027.html"},{"id":93024485,"identity":"6931d554-5854-4477-934c-a427fa4c7503","added_by":"auto","created_at":"2025-10-08 09:17:09","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":160656,"visible":true,"origin":"","legend":"\u003cp\u003eAmyand’s hernia is depicted in a figure obtained following surgery, showing a right indirect hernia containing the vermiform appendix and parts of the colon.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7789897/v1/8f7006fd79e842d6390f28fe.jpeg"},{"id":96593503,"identity":"1fff3fc1-eef2-4d37-aef1-fd14c946aa5f","added_by":"auto","created_at":"2025-11-24 06:54:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":499592,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7789897/v1/a0c6bdaa-3cd9-4865-a280-8151b8a8feee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The role of prophylactic appendectomy in amyand’s hernia with non-inflamed appendix in the elderly: A case report","fulltext":[{"header":"Background","content":"\u003cp\u003eThe incidence of finding a normal appendix within the hernia sac is rare, occuring in less than 1% of inguinal hernia cases.[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] When complications appear such as inflammation, perforation, or strangulation, it becomes extremely uncommon, with an incidence of 0.1%.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] This study presents a distinctive management approach for Amyand\u0026rsquo;s hernia. It highlights the absence of clear consensus for managing Amyand\u0026rsquo;s hernia anatomical variations.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 72-year old man presented with a 6-year history of swelling over his right inguinoscrotal area that had been progressively became larger. He mentioned that the swelling would worsen with exertion, such as straining or coughing but reduced when laying down. The discomfort began as intense, knife-like excruciating pain that eventually turned into localized tenderness. He did not seek any medical advice as it remained asymptomatic for six years. He denied any history of comorbidities, vomiting, nausea, fever, or trauma. There were no any issues with his urinary system and bowel habits. On physical examination, the patient\u0026rsquo;s vitals were stable. Groin examination revealed a soft, tender swelling in the groin extending into the right scrotum. The hernia was reducible and uncomplicated. There were no overlying skin changes, discharge, or bleeding observed during the examination. Bowel sounds were within normal limits. Pre-operative workup, including laboratory and chest X-ray was unremarkable.\u003c/p\u003e\u003cp\u003eThe patient was counseled regarding the need for surgical correction to repair the hernia. After discussing the risks and benefits with the patient, he agreed to proceed with surgery and was scheduled for an elective hernia repair. Under general anesthesia, a standard inguinal incision was made followed by dissection of the inguinal canal. Upon exploration of the hernia sac, it was revealed that a right indirect inguinal hernia contained both the appendix and the bowel (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No signs of inflammation or other abnormalities were found in the appendix. The appendectomy was performed successfully along with excision of the sac. Subsequently, the meshplasty procedure was completed without any complications, with the mesh securely placed over the inguinal canal to reinforce the weakened area. Finally, a sterile dressing was applied to the surgical site after the skin was closed.\u003c/p\u003e\u003cp\u003ePostoperatively, the patient had a smooth recovery and was closely observed for any signs of infection or hernia recurrence. He received a 48-hour course of antibiotics and fluid therapy, oral fluids were administered after 6 hours along with soft diet. He was discharged from the hospital on post-operative day two with appropriate postoperative care instructions and scheduled for follow-up visits at the outpatient clinic. At follow up, the site of incision was healing well with no signs of infection.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current generally accepted treatment approach for Amyand\u0026rsquo;s hernia is fundamentally based on the condition of the appendix within the hernia sac. The Losanoff and Basson system provides a clear framework for surgeons to guide treatment decisions, depending on the degree of appendiceal inflammation (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The first two categories in the Losanoff and Basson classification appear to be the most debated, especially category 2, which remains the most controversial.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In our case, the patient presented with a 6-year history of right inguinoscrotal swelling, eventually diagnosed intraoperatively as an Amyand\u0026rsquo;s hernia type 1. According to the Losanoff and Basson classification, mesh repair and hernia reduction should be done without removing the appendix.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Most authors agree that if the appendix is discovered incidentally without any signs of inflammation, prophylactic appendectomy is not required.[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] On the other hand, some prefer appendectomy in all Amyand\u0026rsquo;s hernia cases regardless of appendix\u0026rsquo;s condition. Those in favor of appendectomy argue that the appendix is susceptible to re-herniate and its removal helps to prevent recurrence, future appendicitis, or the need for additional surgery.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Conversely, others argue that appendectomy increases operative risk, potentially contaminating a previously sterile field and causing unnecessary infections.[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] In addition, dissection of the appendix base may result in a larger incision, weakening the tissue and increase the risk of recurrence.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Ultimately, the rationale behind treatment decision should consider the appendix condition, characteristics of hernia, the patient\u0026rsquo;s clinical conditions such as age, functional status, comorbidity, and life expectancy, and other circumstances not fully identified because of the limited research on this rare disease.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eGiven our patient\u0026rsquo;s clinical profile and the presence of a non-inflamed appendix within the hernia, we opted for appendectomy during the surgery. The decision was made based on the patient\u0026rsquo;s age, general health status, and the potential risks associated with leaving the appendix intact. Furthermore, considering the need to minimize the risk of future herniation reccurence and mitigate the risk of postoperative infection, removal of the appendix was thought to be appropriate. Our decision to perform an appendectomy was further reinforced by Rikki et al. who suggests for appendectomy in all cases of Amyand\u0026rsquo;s hernia to ensure comprehensive treatment.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Additionally, Papaconstantinou et al. demonstrated a significantly high rate of appendectomy, even in the absence of appendiceal inflammation.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] In support of our recommendation, Quartey et al. suggested appendectomy in the absence of inflamed appendix, as seen in their case report of an incarcerated recurrent Amyand\u0026rsquo;s hernia. In their study, the hernia was initially considered as Losanoff type 1, thus appendectomy was not performed, which later progressed into an incarcerated hernia.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Moreover, research has shown that emergency laparotomy or laparoscopy can result in morbidity and mortality rates up to 21% in patients above 65 years.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLosanoff and Bason Classification [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClassification\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSurgical management\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal appendix within an inguinal hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHernia reduction, mesh repairs, appendectomy in young patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute appendicitis within hernia, no abdominal sepsis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAppendectomy through primary repair of hernia, no mesh\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute appendicitis within an inguinal hernia, abdominal wall, or peritoneal sepsis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLaparotomy, appendectomy, primary repair of hernia, no mesh\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute appendicitis within an inguinal hernia, related or unrelated abdominal pathology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eManage as type 1 to 3 hernia investigate or treat second condition as appropriate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study on the repair of a type 1 Amyand\u0026rsquo;s hernia adds to the literature on surgical approaches for Amyand\u0026rsquo;s hernia. Despite being a single report with a favorable outcome, together with a handful of similar successful cases, it stands as a testament to the ongoing need for research into this rare condition. Without further research, surgical decisions may remain sub-optimal and unsupported by evidence, which could lead to higher rates of patient morbidity. More research will ultimately support surgeons in making informed decisions when dealing with this rare entity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of Interest\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003cp\u003eInformed consent was obtained from the patient.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003cp\u003eThe participant has consented to the submission of the case report to the journal.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthors contribution:1. L.C. wrote the original draft, prepared the included figures, and finalized the manuscript for submission.2. I.L.N. reviewed and edited the manuscript.\u003c/p\u003e\n\u003ch3\u003eAddress of correspondence\u003c/h3\u003e\n\u003cp\u003eLa Seine F11/50, Jakarta Garden City, Cakung, East Jakarta, Indonesia\u003c/p\u003e\u003cp\u003e\u003cb\u003eORCID and Email of all authors\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eLaureen Celcilia: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://orcid.org/0009-0002-1472-2568\u003c/span\u003e\u003cspan address=\"https://orcid.org/0009-0002-1472-2568\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e and [email protected]\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIshak Lewi Ndaumanu: [email protected]\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMichalinos A, Moris D, Vernadakis S. Amyand\u0026rsquo;s hernia: a review. Am J Surg. 2014 June;207(6):989\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIvanschuk G, Cesmebasi A, Sorenson EP, Blaak C, Loukas M, Tubbs SR. Amyand\u0026rsquo;s hernia: a review. Med Sci Monit Int Med J Exp Clin Res. 2014;20:140\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLosanoff JE, Basson MD. Amyand hernia: what lies beneath\u0026ndash;a proposed classification scheme to determine management. Am Surg. 2007;73(12):1288\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatoulias D, Kalogirou M, Patoulias I. Amyand\u0026rsquo;s Hernia: an Up-to-Date Review of the Literature. Acta Medica (Hradec Kralove). 2017;60(3):131\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShaban Y, Elkbuli A, McKenney M, Boneva D. Amyand\u0026rsquo;s hernia: A case report and review of the literature. Int J Surg Case Rep. 2018;47:92\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkur MH, Kara\u0026ccedil;ay S, Uygun I, Top\u0026ccedil;u K, \u0026Ouml;zt\u0026uuml;rk H. Amyand\u0026rsquo;s hernias in childhood (a report on 21 patients): a single-centre experience. Pediatr Surg Int. 2013 June;29(6):571\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharma H, Gupta A, Shekhawat NS, Memon B, Memon MA. Amyand\u0026rsquo;s hernia: a report of 18 consecutive patients over a 15-year period. Hernia J Hernias Abdom Wall Surg. 2007;11(1):31\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCankorkmaz L, Ozer H, Guney C, Atalar MH, Arslan MS, Koyluoglu G. Amyand\u0026rsquo;s hernia in the children: a single center experience. Surgery. 2010;147(1):140\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSarici B, Akbulut S, Piskin T. Appendiceal Carcinoid Tumor within Amyand\u0026rsquo;s Hernia: A Case Report and Review of the Literature. Turk J Emerg Med. 2019;19(2):73\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePriego P, Lobo E, Moreno I, S\u0026aacute;nchez-Picot S, Gil Olarte MA, Alonso N, et al. Acute appendicitis in an incarcerated crural hernia: analysis of our experience. Rev Esp Enferm Dig. 2005;97(10):707\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGurer A, Ozdogan M, Ozlem N, Yildirim A, Kulacoglu H, Aydin R. Uncommon content in groin hernia sac. Hernia J Hernias Abdom Wall Surg. 2006;10(2):152\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePsarras K, Lalountas M, Baltatzis M, Pavlidis E, Tsitlakidis A, Symeonidis N, et al. Amyand\u0026rsquo;s hernia-a vermiform appendix presenting in an inguinal hernia: a case series. J Med Case Rep. 2011 Sept;19:5:463.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatoulias D, Kalogirou M, Patoulias I. Amyand\u0026rsquo;s Hernia: an Up-to-Date Review of the Literature. Acta Medica (Hradec Kralove). 2017;60(3):131\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePapaconstantinou D, Garoufalia Z, Kykalos S, Nastos C, Tsapralis D, Ioannidis O, et al. Implications of the presence of the vermiform appendix inside an inguinal hernia (Amyand\u0026rsquo;s hernia): a systematic review of the literature. Hernia J Hernias Abdom Wall Surg. 2020;24(5):951\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuartey B, Ugochukwu O, Kuehn R, Ospina K. Incarcerated recurrent Amyand\u0026rsquo;s hernia. J Emerg Trauma Shock. 2012;5(4):344\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTolstrup MB, Watt SK, G\u0026ouml;genur I. Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy. Langenbecks Arch Surg. 2017 June;402(4):615\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7789897/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7789897/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Amyand’s hernia is defined as an inguinal hernia in which a portion of the appendix is found within the hernia sac. The aim of this report is to present a successfully treated case of Amyand’s hernia and to highlight the diagnostic challenges and appropriate surgical considerations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCase Presentation: We present a rare case of a 72-year-old male patient with a 6-year history of enlarging right inguinal hernia. An inguinal examination was remarkable for a right-sided, tender, reducible mass with scrotal involvement. Intraoperatively, the hernia sac was found to contain a non-inflamed appendix. Given the intraoperative findings, the surgical team proceeded with appendectomy followed by herniotomy and mesh repair. The postoperative course was uneventful and the patient was discharged two days after surgery. At follow-up, the patient remained well without evidence of recurrence or obstruction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDiscussion: While the incidence of Amyand’s hernia is extremely rare (\u0026lt;1%), it can remain asymptomatic until appendiceal inflammation leads to life-threatening complications such as strangulation, necrosis, or perforation. Our patient had a Type 1 Amyand’s hernia, which typically does not require appendectomy. However, given the patient’s age, overall health status, and surgical risks, we opted for appendectomy to prevent future complications. Successful surgical intervention through appendectomy and hernioplasty emphasizes the importance of an individualized intraoperative approach.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: This case adds to the limited literature on surgical management of Amyand’s hernia and underscores the need for tailored management depending on the case. Further large-scale studies is needed to establish evidence-based, standardized protocols to ensure optimal outcomes.\u003c/p\u003e","manuscriptTitle":"The role of prophylactic appendectomy in amyand’s hernia with non-inflamed appendix in the elderly: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 09:17:04","doi":"10.21203/rs.3.rs-7789897/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4088f82c-7c0e-4e37-a299-1bbf24e954a0","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T06:53:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 09:17:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7789897","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7789897","identity":"rs-7789897","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}