Perforated appendicitis with peri-appendicular abscess within an incisional hernia: a report of an unusual case

Amyand’s hernia is a rare phenomenon referring to the presence of an appendix within an inguinal hernia. Hernial appendicitis occurs even more rarely in 0.07-0.13% of cases. Cases have been described in incisional hernias of laparoscopic port sites, nephrectomies and various other incisions. Author described an unusual case of an elderly lady who presented with nausea, fever and a tender abdominal mass over a previous paramedian incision. She was thought to have an incarcerated incisional hernia and was counselled for emergency surgical repair. Intra-operatively, she was found to have a perforated appendicitis with a large peri-appendicular abscess within an incisional hernia. The base of the appendix was unhealthy thus a limited right hemicolectomy was performed and the hernia was repaired primarily. Such cases present atypically and present a diagnostic challenge. Delays in recognition and timely intervention may lead to high morbidity and mortality. The authors hoped to raise awareness of this condition and contribute to the medical literature surrounding this unusual pathology.