Lemmel’s Syndrome as a Cause of Acute Cholangitis: A Case Report with Successful Endoscopic Management

Abstract

Background: Amyand’s hernia is a rare condition characterized by the presence of the vermiform appendix within an inguinal hernia sac. Its incidence is low, and its association with acute appendicitis is even rarer, often leading to diagnostic difficulty. Most cases are diagnosed intraoperatively, particularly when presenting as an incarcerated or strangulated hernia.

Case Presentation: We report the case of a 66-year-old man with a 30-year history of untreated right inguinoscrotal hernia who presented with acute scrotal pain and signs of intestinal obstruction. Physical examination revealed a painful, non-reducible right inguinoscrotal mass. Laboratory studies showed elevated inflammatory markers. Computed tomography demonstrated an incarcerated right inguinal hernia containing bowel loops. Emergency surgical exploration was performed. Intraoperatively, an inflamed appendix with a periappendiceal abscess was identified within the hernia sac. Appendectomy, abscess drainage, and herniorrhaphy were successfully performed. The postoperative course was uneventful, and the patient was discharged in good clinical condition. Histopathological examination confirmed acute nonspecific appendicitis without perforation.

Conclusion: Amyand’s hernia complicated by acute appendicitis is an uncommon surgical finding that may mimic an incarcerated inguinal hernia. Early surgical intervention and individualized management based on intraoperative findings are essential to achieve favorable outcomes.