Spontaneous rupture of left inguinal abscess as a manifestation of Amyand's hernia with acute appendicitis. A case report

Background: Amyand’s hernia is defined as the presence of the vermiform appendix within an inguinal hernia sac. It is a rare entity, with an incidence ranging from 0.2% to 2% of inguinal hernias, and even more uncommon when located on the left side. Left-sided cases are usually associated with mobile cecum, intestinal malrotation, or situs inversus, making diagnosis particularly challenging. We report the case of a 62-year-old male presenting with a three-week history of left inguinal pain and spontaneous drainage of foul-smelling purulent material from the scrotal region. Physical examination revealed bilateral inguinal hernias, with inflammatory signs and fistulous drainage on the left side. Computed tomography demonstrated intra-abdominal collections extending to the left inguinal region, suggestive of acute appendicitis within a hernia sac. Intraoperative findings confirmed a left-sided Amyand’s hernia with phase II acute appendicitis. Appendectomy and hernia repair without mesh were performed due to contamination risk. Given its rarity and atypical presentation, left-sided Amyand’s hernia represents a diagnostic challenge and is often identified intraoperatively. Knowledge of its classification, particularly the Losanoff and Basson system, is essential to guide appropriate surgical management. Keywords: Appendix, Amyand’s hernia.