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

Abstract

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.