Extra-Abdominal Appendicitis: A Case Report From an Amyand Hernia

Introduction Hernioplasty is one of the most common procedures in general surgery. The post-operative period extends until 6 months of surgery, to detect early recurrence. This aims to share the management of appendicitis in a recurrent hernia. Methods This is a case report based on a patient who presented as an Amyand hernia, complicated with appendicitis. Results This case is from a male patient aged 50 years, who was submitted to an elective right inguinal hernia repair 8 months before, without other relevant past medical history. He presented in the emergency room with right groin pain, nausea, vomiting and fever. Blood tests showed increased white blood cells (14,000/mm3) and increased C-reactive protein (11 mg/dL). In the ultrasound performed, there were signs of recurrence of the hernia, the appendix was noted to be part of the hernia contents and it had findings suggestive of appendicitis. The patient underwent emergency surgery. Intraoperatively, there was incarceration of the appendix and the cecum. Appendectomy was completed without further intestinal resection. The hernia defect was corrected with a mesh based technique. Postoperative period went without complications and the patient was discharged on day 2 postoperative with amoxicillin-clavulanate. Histology showed appendicitis. Discussion This case reports the rare event of appendicitis in the context of an Amyand hernia. This is important to raise awareness for this condition, which can mimic an incarcerated hernia. The management of the patient is relevant to be shared and discussed with hernia experts to improve management of future patients with the same condition.