Complicated Amyand's Hernia with Cecal Perforation and Diffuse Peritonitis Managed by Total Colectomy: Case Report and Literature Review

Amyand's hernia is a rare condition defined by the presence of the vermiform appendix within an inguinal hernia sac, accounting for about 0.4 to 1% of inguinal hernias, with acute appendicitis within the sac in fewer than 0.1% of cases. Cecal perforation combined with massive colonic dilatation is exceptionally rare. We report a 43-year-old woman with a ten-year history of chronic methamphetamine use and no other relevant background, who presented with seven days of progressive abdominal pain, fever, bilious vomiting, distension, constipation, and absence of flatus. Examination showed generalized peritoneal irritation and marked distension, and computed tomography demonstrated pneumoperitoneum, free intraperitoneal fluid, marked colonic dilatation, and the cecum within a right inguinal hernia sac. Emergency laparotomy revealed a complicated Amyand's hernia with near-total destruction of the appendix, cecal perforation, diffuse purulent peritonitis (about two liters), a right inguinal abscess, massive colonic dilatation, and a left tubo-ovarian abscess. The patient underwent total colectomy, terminal Brooke ileostomy, left salpingo-oophorectomy, drainage of the inguinal abscess, and primary intra-abdominal hernia repair without mesh. Recovery was uneventful, and she was discharged on postoperative day eight. Prompt surgery and operative management individualized to the intraoperative findings are essential when complicated Amyand's hernia presents with severe intra-abdominal sepsis.