A Case of Amyand's Hernia With Abscess Managed by Two-Stage Surgery: Elective Hernia Mesh Repair Following Emergency Laparoscopic Appendectomy.

Abstract

An 82-year-old man presented to our emergency department with a bulge in the right groin and worsening pain that had been present for one week. An abdominal computed tomography scan revealed fluid collection within a right inguinal hernia and a thickened appendix within the hernia sac. The patient underwent an emergency laparoscopic appendectomy under a diagnosis of Amyand's hernia with peri-appendicular abscess. During surgery, the incarcerated appendix was pulled back into the abdominal cavity from the hernia sac, and the perforated appendix was resected. For drainage of the abscess, a drain tube was laparoscopically placed into the hernia sac through the internal inguinal ring. Considering the risk of mesh infection and wound infection, the patient underwent appendectomy alone but not hernia repair at this time. Two months later, Lichtenstein repair using mesh was performed as a second-stage procedure. For Amyand's hernia with abscess, this type of two-stage strategy may avoid the surgical site infection, and the use of mesh in a second procedure would minimize the possibility of hernia recurrence, unlike previously reported cases treated by concomitant appendectomy and hernia repair.