A rare guest in the hernia sac: Preoperatively diagnosed Amyand's hernia with gangrenous appendicitis

Amyand's hernia is a rare clinical entity defined by the presence of the vermiform appendix within an inguinal hernia sac, with acute appendicitis occurring in this setting being exceptionally uncommon. We report the case of a 57-year-old male who presented with pain in a known right inguinal hernia. Clinical evaluation demonstrated an incarcerated right inguinal hernia, and contrast-enhanced computed tomography showed an inflamed appendix herniating into the right inguinal canal, consistent with acute appendicitis within an Amyand's hernia. The patient underwent urgent laparoscopic exploration, which confirmed an acutely inflamed, gangrenous appendix partially contained within the hernia sac. A laparoscopic appendectomy was successfully performed, and the appendix was reduced from the hernia sac. Given the gangrenous nature of the appendix and concerns regarding microperforation and potential infection, inguinal hernia repair was deferred. The patient recovered without immediate complications. This case highlights the diagnostic value of preoperative imaging, the feasibility of a minimally invasive approach, and the importance of individualized surgical decision-making for Amyand's hernia. In selected patients with acute appendicitis and suspected perforation within the hernia sac, laparoscopic appendectomy without concurrent hernia repair can be considered, minimizing operative risk while allowing staged definitive hernia management.