Amyand’s Appendicitis in Giant Inguinoscrotal Hernia with 18 Years of Evolution: Case Report and Literature Review

Abstract

Giant inguinoscrotal hernia is a rare entity, generally resulting from prolonged evolution without adequate treatment. Its surgical correction poses significant challenges due to loss of abdominal domain and the risk of abdominal compartment syndrome after reduction of the hernia contents. Amyand’s appendicitis, defined as the presence of an inflamed cecal appendix within the hernia sac, represents a rare condition whose coincidence with a giant hernia is exceptional. We present the case of a 41-year-old male patient with an 18-year history of a right inguinoscrotal hernia who was admitted with acute abdominal pain. During surgery, a hernia sac measuring 40 × 30 cm containing ileal loops, free fluid, and an inflamed appendix was identified. Appendectomy, segmental ileal resection with side-to-side anastomosis were performed, and the abdomen was left open using negative pressure therapy due to the high risk of abdominal compartment syndrome. The postoperative course was favorable. This case represents a rare combination reported in the literature and highlights the need for an individualized surgical approach, avoiding prosthetic materials in contaminated contexts and considering strategies such as open abdomen in giant hernias with loss of domain.