Acute appendicitis in Amyand’s hernia in a case of incarcerated right inguinal hernia: an unusual presentation

Abstract

Amyand’s hernia, defined as the presence of the vermiform appendix within an inguinal hernia sac, is a rare clinical entity, representing approximately 1% of all inguinal hernias. The occurrence of acute appendicitis within an Amyand’s hernia is exceptionally uncommon, seen in only about 0.1% of cases. Awareness of this condition is important, as delayed recognition can lead to serious complications including perforation and sepsis. We report two cases of Amyand’s hernia presenting as incarcerated right inguinal hernia with acute appendicitis. The first patient, a 61-year-old male, presented with a painful, irreducible right inguinal swelling, nausea, vomiting, and fever. The second patient, a 48-year-old male, had similar symptoms with a history of long-standing reducible inguinal swelling. In both cases, ultrasonography revealed features of incarcerated indirect inguinal hernia with early strangulation. Intraoperatively, both hernia sacs contained an inflamed appendix adherent to the sac wall. Open appendectomy and modified Bassini’s herniorrhaphy were performed without mesh placement due to the risk of infection. Postoperative recovery was uneventful, and histopathological examination confirmed acute appendicitis in both cases. Amyand’s hernia with acute appendicitis is a rare surgical finding that can mimic an incarcerated or strangulated hernia. Preoperative diagnosis is challenging, and most cases are identified intraoperatively. Timely surgical management with appendectomy and non-mesh hernia repair is essential to prevent septic complications and ensure favorable outcomes.