Amyand's hernia; a case report in King Fahad Hospital, Medina

Background: Hernia is the protrusion of an organ or its fascia through the wall of a containing cavity. Ventral abdominal and inguinal hernias typically contain bowel or omentum; only rarely and incidentally the appendix is discovered within the herniated region known as Amyand's hernia (AH).
Case Presentation: A 72-year-old male patient with a past surgical history of bilateral hernia repair and prostatectomy presented to the emergency department complaining of lower abdominal and severe scrotal pain with progressive scrotal swelling for 4 months associated with urinary retention and anorexia. On examination, the right scrotum was hugely enlarged and severely tender. Computed tomography (CT) concluded a large (wide neck 7 cm) right inguinal hernia causing mass effect on the urethra, intra-hernia appendix with radiological signs of acute inflamed appendix. The patient was admitted to the general surgical ward and underwent appendectomy and hernia mesh repair. The patient was observed for 1 week and no postoperative complications were seen. The patient was discharged on post-operative day 7 and followed up in the outpatient clinic.
Conclusion: A definitive preoperative diagnosis of asymptomatic AH is rare as most cases are usually diagnosed during surgery. CT abdomen and pelvis remains the imaging modality of choice with groin mass or symptomatic hernia.