Perforated appendicitis in Amyand's hernia with generalized peritonitis: a case report.

Amyand's hernia is an uncommon inguinal hernia containing the vermiform appendix. Preoperative diagnosis remains difficult, and many cases are recognized only during surgery. We report a 64-year-old man with a 33-year history of a reducible right inguinal hernia who presented with 5 days of irreducibility, groin pain, fever, and diffuse abdominal pain. Examination showed generalized peritonitis. Ultrasonography demonstrated a fluid-filled right inguinal hernia sac containing a tubular structure, free intraperitoneal fluid, and dilated bowel loops. Emergency inguinal exploration released purulent fluid and revealed the cecum with a gangrenous perforated appendix inside the hernia sac. Because purulent material tracked freely through the internal ring, the procedure was immediately converted to lower midline laparotomy. Appendectomy, abdominal lavage, drainage, and tissue-based hernia repair without mesh were performed. The patient recovered well and was discharged on postoperative day 16.