Surgical Decision-Making in Amyand's Hernia According to the Losanoff and Basson Classification: A Case Report

Amyand’s hernia is a rare clinical entity characterized by the presence of the vermiform appendix within the sac of an inguinal hernia, with or without appendiceal inflammation. It accounts for approximately 0.4–1% of all inguinal hernias, while the coexistence of acute appendicitis is reported in less than 0.1% of cases. Owing to its low incidence and nonspecific clinical presentation, preoperative diagnosis is uncommon, and the condition is most often identified intraoperatively. We report the case of a 45-year-old male who presented with a painful, nonreducible right inguinal mass clinically consistent with an incarcerated inguinal hernia. Emergency surgical exploration revealed an inflamed but nonperforated vermiform appendix within the hernia sac, confirming the diagnosis of Amyand’s hernia. Appendectomy was performed through the inguinal approach, followed by primary tissue-based hernia repair without mesh, in accordance with the Losanoff and Basson classification for Type 2 Amyand’s hernia. The postoperative course was uneventful, and histopathological examination confirmed acute nonperforated appendicitis. No postoperative complications or hernia recurrence were observed during follow-up. Amyand’s hernia represents a diagnostic and therapeutic challenge for the general surgeon, and its management must be individualized based on intraoperative findings. The Losanoff and Basson classification remains a valuable tool for guiding surgical decision-making, particularly regarding appendectomy and the safe use of prosthetic material.