In a rare medical occurrence, a 78-year-old man from Kurnool was diagnosed with Amyand’s Hernia, a condition where the appendix enters a hernia and ruptures. This case posed significant challenges due to the patient’s pre-existing heart condition, requiring meticulous surgical intervention. The emergency surgery was successfully performed at KIMS Hospital, Kurnool, by Consultant Surgical Gastroenterologist, Dr. S.J. Janakiram.

Generally, the appendix is located in the lower right abdomen near the navel. However, in this patient, the appendix had moved down to the groin region and had ruptured inside a hernia. “This is an extremely rare occurrence, seen in only 0.1% of cases,” stated Dr. Janakiram.

The patient had undergone heart valve replacement surgery four years ago and was on blood-thinning medication, which added complexity to the surgical procedure. “Performing surgery under these circumstances required a multi-disciplinary approach. First, we consulted a cardiologist to temporarily stop the blood-thinning medication for a day. However, since the appendix had already ruptured, delaying surgery was not an option due to the risk of life-threatening infection,” Dr. Janakiram explained.

The surgical team proceeded with a laparoscopic appendectomy, during which they discovered severe swelling and pus accumulation inside the ruptured appendix. The entire infected area was carefully cleaned before switching to an open surgical procedure to repair the hernia. Typically, a mesh is used in hernia repairs, but due to the presence of infection, sutures were used instead.

The patient was able to resume his regular medication the day after surgery and was discharged in stable condition after four days. “Cases like these are exceptionally rare and are mostly found in medical literature. Successfully performing this surgery, especially in a 78-year-old patient with a history of heart surgery, was a significant challenge, but we were able to achieve a positive outcome,” Dr. Janakiram concluded.