Gangrenous appendicitis within a long-standing umbilical hernia: a case report

Appendicitis occurring within an umbilical or paraumbilical hernia is an extremely rare clinical entity and poses a significant diagnostic challenge. Because umbilical hernia sacs usually contain omentum or bowel, the presence of the appendix may obscure classical features of appendicitis and mimic a strangulated hernia. We report the case of a 63-year-old woman with a 29-year history of umbilical hernia who presented with acute pain, erythema, and an irreducible umbilical mass. She underwent emergency surgical exploration, which revealed gangrenous omentum and a gangrenous appendix measuring 10 × 2 cm within the hernia sac. Appendectomy, omentectomy, and primary layered hernia repair were performed. The postoperative course was uneventful. This case highlights that appendicitis within an umbilical hernia, although rare, should be considered in patients presenting with an acutely painful irreducible umbilical hernia, as prompt surgical intervention leads to excellent outcomes.