Hernia (2009) 13:225–227 DOI 10.1007/s10029-008-0429-2 123 CASE REPORT Can preoperative diagnosis aVect the choice of treatment in Amyand’s hernia? Report of a case A. Karatas · O. Makay · Z. Salihoflu Received: 30 June 2008 / Accepted: 20 August 2008 / Published online: 16 September 2008  Springer-Verlag 2008 Abstract Amyand’s hernia (AH) is deWned as an appen- dix located in the inguinal hernia sac. Most cases are diag- nosed intraoperatively and might undergo appendectomy besides hernia repair. Computerized tomography is eVec- tive in the preoperative diagnosis. Meanwhile, the number of reports concerning the preoperative diagnosis of AH is increasing. There is no standard protocol for the manage- ment of AH. Factors such as the presence of an inXamed appendix, contamination of the surgical Weld, patient age and anatomic features of the tissue are important determi- nants for appropriate surgery. Herein, we report an adult male patient with AH. Keywords Inguinal hernia · Amyand’s hernia · Diagnosis Introduction Amyand’s hernia (AH) is deWned as the presence of the appendix in the inguinal hernia sac. The incidence of an asymptomatic appendix inside the hernia sac is 1% and the occurrence of appendicitis is about 0.13% [1]. It can be seen in a very wide of the population [2]. Commonly, the appendix is very long and located retrocaecally, and in some cases, terminal ileum and caecum can also be seen in the sac [3, 4]. The occurrence of appendicitis in such situa- tions can be detected during the operation and it should be treated by appendectomy and hernia repair. There is no consensus to perform appendectomy if the appendix is asymptomatic. Although some cases detected by preopera- tive ultrasonography are reported, computerized tomogra- phy is the most eVective method for its diagnosis and the number of reports concerning AH have increased in the last several years. Case A 20-year-old male patient was admitted with an unreduc- ible scrotal mass (right sliding inguinal hernia). He noted that he had had a swelling in the groin since his childhood, which descended to the scrotum during the last several years and had become unreducible. He did not complain about nausea, vomiting or pain. For another study in which we were planning to compare postoperative scrotal oedema with preoperative Wndings, we performed preoperative scrotal ultrasonography in this case. According to the Wnd- ings, intestinal movements were detected in the scrotum. The Bassini incision was made during the operation under general anaesthesia. The terminal ileum, caecum and appendix were seen in the hernia sac (Fig. 1). These organs were adhered to the right testis in the scrotum. The appen- dix was normal (Fig. 2). Adhesions were divided by sharp dissection and the testis was left in the scrotum. Appendec- tomy was not performed. The terminal ileum, caecum and appendix were brought back into the abdomen. The hernia repair was done by carrying out a Lichtenstein hernioplasty A. Karatas (&) Department of Surgery, Cerrahpasa Medical Faculty, Kocamustafapasa, Istanbul, Turkey e-mail: dradem@hotmail.com O. Makay Department of General Surgery, Ege University Medical Faculty, Izmir, Turkey Z. Salihoflu Department of Anesthesia, Cerrahpasa Medical Faculty, Istanbul, Turkey