Large incarcerated inguinoscrotal type I Amyand's hernia managed with appendix preserving Lichtenstein mesh repair: a case report

Amyand's hernia is the presence of the vermiform appendix within an inguinal hernia sac and represents an uncommon intraoperative finding whose management depends on appendiceal viability and operative-field contamination. We report a 70-year-old man with a six-week history of a right inguinal hernia who developed one week of progressive inguinoscrotal enlargement, pain rated 8/10, and absence of bowel movements despite preserved flatus. Examination showed a large, firm, nonreducible right inguinoscrotal hernia without skin inflammatory changes or clinical peritonitis. Plain pelvic radiographs demonstrated marked right hemiscrotal enlargement with bowel-containing herniation. Because urgent surgery was indicated, no ultrasonography or computed tomography was obtained. Open exploration revealed a large indirect inguinoscrotal sac measuring approximately 15 × 10 cm. Controlled opening demonstrated the cecum and a macroscopically normal appendix without inflammation, ischemia, perforation, or contamination, establishing a Losanoff-Basson Type I Amyand's hernia. The appendix was preserved and reduced, the redundant sac was resected, and a tension-free Lichtenstein repair with polypropylene mesh was completed. Recovery was uncomplicated. At two-week follow-up, there was no edema, clinical recurrence, testicular abnormality, or other identified complication. This case illustrates that urgent symptoms and large scrotal extension do not necessarily imply appendiceal inflammation and supports a contamination-directed strategy in which a normal appendix may be preserved while definitive prosthetic hernia repair is performed.