A Case Report of Amyand's Hernia in a Previously Mesh-Repaired Groin: Surgical Decision-Making in a Contaminated Field.

Amyand's hernia is a rare clinical entity defined by the presence of the vermiform appendix within an inguinal hernia sac, and its management remains controversial, particularly in the presence of contamination and prior mesh repair. We report the case of a 74-year-old man presenting with acute right inguinal pain suggestive of a strangulated recurrent inguinal hernia. Intraoperatively, a gangrenous appendix was identified within the hernia sac with 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, and the patient received piperacillin/tazobactam and metronidazole. The postoperative course was uneventful, and at one-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights the importance of individualized surgical decision-making in complex contaminated hernia cases, particularly regarding the management of previously implanted mesh.