Generalized peritonitis due perforated appendix in an Amyand's hernia: an unusual presentation of a rare condition

ABSTRACT

We report a 70 year-old male patient who had Amyand's hernia with an unusual clinical presentation. At surgery, the vermiform appendix was perforated and there was an abscess within the hernial sac associated with generalized peritonitis and multiple intra-abdominal abscesses. The preoperative differential diagnosis was incarcerated diaphragmatic hernia, colonic volvulus, or inguinal hernia associated with peritonitis. Although abdominal computed tomography successfully diagnosed the inguinal hernia, it could not demonstrate the appendix within its sac. As in the majority of published series, Amyand's hernia was discovered only intra-operatively. Through a midline laparotomy, the appendix remnants were excised and multiple intra-abdominal abscesses were evacuated. The patient had no postoperative complications and was discharged in a fair condition on the 8th postoperative day