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Erschienen in:
01.06.2008 | Letter to the Editor
Amyand hernia: a classification to improve management
Erschienen in: Hernia | Ausgabe 3/2008
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We read with great interest the recent report by Milanchi and Allins [1] on history, imaging, and management of Amyand’s hernia. The authors recommend reduction of the appendix and mesh hernioplasty if there is no acute appendicitis, and appendectomy followed by endogenous repair if an inflamed vermiform appendix is found [1]. Although the recommendations of Milanchi and Allins are certainly acceptable, they do not fully reflect the potential variability of clinical scenarios resulting from the four basic types of Amyand’s hernias (Table 1). While the authors’ recommendations apply to Amyand Types I and II, the management of Types III and IV are more complex, and should also be considered.
Table 1
Pathological types of Amyand’s hernia and their respective management
|
Type of hernia
|
1
|
2
|
3
|
4
|
|---|---|---|---|---|
|
Salient features
|
Normal appendix
|
Acute appendicitis localized in the sac
|
Acute appendicitis, peritonitis
|
Acute appendicitis, other abdominal pathology
|
|
Surgical management
|
Reduction or appendectomy (depending on age), mesh hernioplasty
|
Appendectomy through hernia, endogenous repair
|
Appendectomy through laparotomy, endogenous repair
|
Appendectomy, diagnostic workup and other procedures as appropriate
|