Two-stage management of Amyand’s hernia with extensive inguinal abscess: laparoscopic appendiceal transection followed by laparoscopic hernia repair: a case report

Introduction: Amyand's hernia is a rare pathological condition characterized by the presence of the appendix in an inguinal hernia sac. In some cases, it is accompanied by perforated appendicitis, posing a challenging clinical scenario in which the surgeon must address both appendicitis with abdominal sepsis and hernia repair. Case presentation: A 78-year-old man presented to our hospital with a bulge in the right groin and was diagnosed with Amyand's hernia with an extensive inguinal abscess on computed tomography. The patient underwent emergency laparoscopic appendiceal transection and groin percutaneous abscess drainage for perforated appendicitis within an inguinal hernia with a groin abscess. The patient was uneventfully discharged on postoperative day 10. Several months later, transabdominal preperitoneal repair with mesh for bilateral inguinal hernia and removal of the scarred residual appendix were performed as second-stage management. Discussion: Infection control should be prioritized in cases of perforated appendicitis with abscess formation. In cases with no or minimal inflammation, concurrent hernia repair with mesh and appendectomy may be feasible. However, considering the risk of infection, elective hernia repair with a mesh is the preferred approach after inflammation subsides. Conclusion: We highlighted the importance of individualized surgical management of Amyand's hernia with severe inflammatory pathology.