Perforated Appendiceal Mucocele within an Amyand's Hernia: A Case Report and a Brief Review of Literature

Backround : Amyand's hernia (AH) is a rare type of inguinal hernia, containing the appendix in the hernia sac irrespective of the presence of appendicitis. Appendiceal mucocele represents a dilation of the appendix with an accumulation of mucinous material and could be either a benign or a malignant process. Herein we report an exceptionally rare case of a perforated appendiceal mucocele within an AH. Case Report : A 77-year-old male patient, underwent surgery for right incarcerated inguinoscrotal hernia. He was found to have a perforated, phlegmonous, and dilated appendix dislocated from the caecum, with peri-appendicular purulent content with fibrin deposits within the hernia sac. Also, the last ileal loop, caecum, ascendant colon, and the right testicle within the hernia sac, were compromised due to the septic process around. A right hemicolectomy and orchiectomy, followed by a herniorrhaphy without using a synthetic mesh, was performed. Histopathological examination revealed a perforated benign appendiceal mucocele associated with phlegmonous appendicitis and fibrinous peritonitis. Conclusion : This case report describes a rare combination of entities: an AH that presented as an incarcerated hernia and was diagnosed intraoperatively with a perforated, phlegmonous, and dilated appendix, proving to be an appendiceal mucocele.