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

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.

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Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Committee of Juntendo University Nerima Hospital issued approval S24-05. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.