Drain Site Herniation of the Vermiform Appendix: A Rare Complication Following Laparotomy

A 65-year-old woman presented with an exceptionally rare complication of appendiceal herniation through a previous surgical drain site, occurring two years after a radical distal gastrectomy performed for gastric adenocarcinoma. To date, only four similar cases have been reported in the literature. The patient initially developed an asymptomatic, reducible hernia at the drain site two years postoperatively. Subsequently, she presented acutely with features of intestinal obstruction, including localized tenderness, nausea, and vomiting. Ultrasonography revealed bowel obstruction within a hernia sac protruding through an 8.9-mm fascial defect corresponding to the former drain site. At laparotomy, the incarcerated vermiform appendix was identified within the hernia sac, demonstrating luminal obstruction and serosal inflammation without evidence of gangrene. An appendicectomy was performed, followed by anatomical repair of the fascial defect. This case underscores the necessity of meticulous fascial closure at drain sites specially when using bigger drain and highlights the diagnostic challenges associated with atypical incisional hernias presenting long after major abdominal surgery.