Amyand’s Hernia in a Previously Mesh-Repaired Groin: Intraoperative Decision-Making in a Contaminated Field

Abstract

Background: Amyand’s hernia is a rare clinical entity defined by the presence of the vermiform appendix within an inguinal hernia sac. Its management remains controversial, particularly in the presence of contamination and prior mesh repair.

Case presentation: A 74-year-old male presented with acute right inguinal pain suggestive of a strangulated recurrent inguinal hernia. Intraoperatively, a gangrenous appendix was identified within the hernia sac, accompanied by purulent contamination. Appendectomy and peritoneal lavage were performed via a combined inguinal and McBurney approach. Due to contamination, no new mesh was placed, while the previously implanted mesh was preserved. Microbiological analysis revealed Escherichia coli sensitive to the administered antibiotic regimen. The patient received piperacillin/tazobactam and metronidazole for five days. The postoperative course was uneventful and at one-month follow-up, the patient remained asymptomatic, with complete wound healing and no evidence of recurrence.

Conclusion: In contaminated Amyand’s hernia, avoidance of new mesh combined with preservation of previously implanted prosthetic material may represent a safe and effective surgical strategy.