Strangulated Right Inguinoscrotal Hernia Containing Terminal Ileum, Cecum and Appendix in a 53-Year-Old Man: Case Description and Operative Management Based on Literature Evidence

Background: The simultaneous presence of the cecum and appendix within an inguinal hernia sac—referred to as a “ceco-appendicular hernia,” often a sliding variant—is rare and mostly diagnosed intraoperatively. Surgical management (reduction, appendectomy, tissue-based vs mesh repair) depends on visceral viability and the degree of contamination. The Losanoff & Basson classification remains the standard decision-making framework. Case Presentation: A 53-year-old man presented with a 10-year history of a right inguinoscrotal hernia, recently becoming painful, irreducible, and associated with bowel obstruction. Emergency inguinal exploration revealed strangulated but viable terminal ileum, cecum, and appendix. Reduction was achieved, and a Bassini tissue repair was performed, without appendectomy and without mesh reinforcement. Postoperative recovery was uneventful (discharge on postoperative day 1). Discussion: We provide a focused review of reported clinical variants (right/left-sided, giant, perforated, sliding) and discuss the role of imaging (CT) and operative recommendations guided by the Losanoff & Basson classification. Conclusion: In strangulated hernias, non-mesh repair is preferred when contamination is suspected. Appendectomy should be individualized depending on appendiceal status. Mesh placement is acceptable only in a clean surgical field.