Amyand and de Garengeot' hernias


Dear Editor,

We read with great interest the case of an Amyand’s hernia reported by Salemis et al. [1]. Although the presence of an inXammed appendix within a hernia sac rarely occurs (0.13–1% of all cases of appendicitis), it remains an exciting subject with more than ten reports published during the last decade in Hernia, the very latest on February [2]. As outlined by the authors, many of these patients underwent emergency surgery without preoperative CT scan because of suspected strangulated hernias. Fortunately, it has become more frequent to obtain a CT scan without harm- fully delaying surgery. CT scan is very useful in this situa- tion as highlighted by Luchs et al. [3]. This gives rise to a new semiology that we have to learn. Like in every abdom- inal emergency, CT scan indicates the presence or the absence of obstruction, Xuid collection, and inXammation and helps to predict hernia content, particularly in these complicated hernias. Amyand’s hernia, suspected when the content, although visceral, is not clearly intestinal nor omental (Fig. 1), is asserted when a tubular structure con- nected to the caecum is visualised, as shown in our example (Fig. 2). Furthermore, CT scan helps the surgeon in the choice of an appropriate route and strategy. The absence of an image of abdominal complication or diVusion allows to avoid a large midline incision and to choose an inguinal (Amyand’s hernia) or femoral (de Garengeot’s hernia [4]) approach, that is, in most cases suYcient to achieve a non- prosthetic hernia repair as well as an appendicectomy, completed with a laparoscopic control (or laparoscopic appendicectomy) if any doubt or diYculty arises.


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