Abstract
Amyand's hernia is a rare type of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac, accounting for less than 1% of all inguinal hernias, while acute appendicitis within the sac occurs in only 0.07–0.13% of cases. Recurrent incarcerated Amyand's hernia complicated by acute phlegmonous appendicitis is exceptionally rare, making this case unique. We report the case of a 72-year-old man who presented with a painful irreducible right inguinal mass, nausea, vomiting, and generalized weakness one year after bilateral tissue-based inguinal hernia repair without mesh implantation. Ultrasonography suggested a recurrent incarcerated inguinal hernia, whereas the definitive diagnosis was established intraoperatively. Emergency surgery revealed a right-sided type II Amyand's hernia containing an inflamed vermiform appendix. Appendectomy, hernia sac excision, and tissue-based posterior wall repair without mesh were performed. Histopathological examination confirmed acute phlegmonous appendicitis, and bacteriological culture identified Pseudomonas aeruginosa. The postoperative course was uneventful, and the patient was discharged on postoperative day four. This case highlights the exceptional rarity and diagnostic difficulty of recurrent Amyand's hernia with acute appendicitis and supports individualized tissue-based hernia repair without mesh in contaminated surgical fields.