Groin abscess outside the hernia sac secondary to perforated appendicitis in an older adult: a case report.

Groin abscesses secondary to acute appendicitis are rare, particularly when inflammation spreads retroperitoneally and the abscess forms outside the hernia sac rather than within such as occurs in Amyand's hernia. An 84-year-old woman with advanced breast cancer and a known inguinal hernia developed a progressively enlarging right groin mass 4 days after mastectomy. Computed tomography revealed a fluid collection, and needle aspiration confirmed an abscess. Conservative management led to temporary improvement; however, a recurrent abscess near the cecum appeared 31 days later. Surgical intervention revealed a partially perforated appendix, indicating retroperitoneal extension of appendiceal inflammation as the cause of the groin abscess, and appendectomy was performed. The patient recovered without recurrence at the three-month follow-up. Acute groin swelling in patients with inguinal hernia should prompt suspicion for appendicitis-related abscess, even without typical abdominal symptoms. Early imaging is essential, particularly in older adults with atypical presentations.