Discussion There are several clinical manifestation of Amyand’s hernia: reducible or incarcerated hernia within non-inflamed appendix, or inflamed appendix (hernia appendicitis) and ingested foreign body which may be metallic or non metallic in appendix causing perforation or not. Nowadays all these presentations of vermiform appendix within inguinal hernia sac are called Amyand’s hernia. Non inflamed appendix in children is found in about 1% of herniotomies,

usually as incidental finding. Inflamed vermiform appendix in inguinal hernia sac (hernia appendicitis or Amyand’s appendicitis) is ten-folds rarest [4–6]. Foreign body (pin) Amyand’s appendicitis is extremely rare, perhaps one case per century. The first published case by Amyand was in London an Alisertib nmr 11-year-old boy complaining of right inguinal hernia and fistulous abscess. In inguinal hernia sac he found the vermiform appendix and a fistula tract caused by the perforation by ingested pin. Trans-hernia sac appendectomy was done. Half-hour surgery was very painful to the patient and very laborious to surgeon, after one month the patient recovered, but the hernia recurred [7]. Hundred and fifty years later in New York,

in 1886 Hall had a similar case of 17-year-old boy (incarcerated Amyand’s hernia pin perforated appendicitis) and trans hernia sac appendectomy and herniorrhaphy was done. Patient recovers, but hernia was recurrent. This is the first successful appendectomy recorded in USA [3]. Fowler’s review (1912) collected 63 published cases of pins in the appendix, 23 of them in children check details under eleven years. In this series of cases only four cases have been Amyand’s hernias [8]. Watson (1923) collected 512 cases of hernia of the appendix (about 55% of them being in inguinal hernia), and Ryan has collected 537 published cases of vermiform appendix within inguinal hernia up to 1937 [4]. Reviewing of English language surgical literature from 1937 to 2006 on acute appendicitis presenting within an inguinal or femoral hernia Meinke found only eight cases of children and in

all of them inflamed appendix vermiform was found Clomifene in inguinal hernia [9]. Recently no pin hernia appendicitis was reported [10–12][13]. 271 years after Amyand, and 120 years after Hall we operated on 6-year-old boy with right incarcerated Amyand’s hernia pin perforated appendicitis. Appendectomy and herniotomy was done and patient had uneventful course. During three year follow-up no recurrence occurred. Historically Amyand’s hernia is see more diagnosed intra-operatively, but preoperative Ultrasound and/or CT scan (2000) can make a correct diagnosis [12, 13]. Conclusion Foreign body (pin) Amyand’s hernia appendicitis seems to be extremely rare, maybe once in a century (Amyand 1735, Hall 1886, and our case in 2006).