Amyand's Hernia With Perforated Appendicitis: Surgical Strategies in the Infected Field

ABSTRACT

Amyand's hernia is a rare subtype of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. The estimated incidence of Amyand's hernia with concurrent appendicitis is only 0.1% of all cases. A 66‐year‐old male presented with a 5‐day history of right groin swelling, erythema and burning sensation, but without abdominal pain. Laboratory investigations revealed leukocytosis and elevated C‐reactive protein. CT imaging suggested an Amyand's hernia with appendicitis. Emergency surgery via a lower midline laparotomy revealed a perforated appendix and purulent material within the hernia sac. Appendectomy and abdominal lavage were performed. Due to gross inflammation, hernia repair was deferred. An additional inguinal incision was made to evacuate the abscess. This case highlights the diagnostic and treatment challenges of Amyand's hernia, particularly in the absence of classic signs of appendicitis. Timely imaging and individualized surgical management are crucial to optimize outcomes.