Hernia with cecum and appendix incarceration: case report and narrative literature review

Abstract

Unusual visceral contents in incarcerated groin hernias are uncommon and may complicate both diagnosis and operative planning. The presence of the vermiform appendix inside an inguinal hernia sac characterizes Amyand’s hernia, whereas concomitant cecal incarceration represents an even less frequent variant. We report a case of right inguinal hernia containing the cecum and appendix, presenting as a painful, irreducible groin mass. Abdominal computed tomography suggested incarceration without frank perforation. Emergency surgery identified a congested but viable cecum and appendix; appendectomy, reduction of the cecum, and mesh hernioplasty were performed, with an uneventful recovery. A narrative review of the literature was added to contextualize epidemiology, anatomic variants, the role of preoperative imaging, classification systems, and operative strategy. The review confirms that preoperative CT improves diagnostic confidence, but final management still depends primarily on intraoperative assessment of contamination, appendiceal inflammation, bowel viability, and hernia anatomy. In clean fields, prosthetic repair is generally acceptable; when appendicitis, perforation, or cecal compromise is present, the repair should be individualized, often avoiding mesh. Awareness of this rare entity allows the surgeon to anticipate unexpected sac contents and tailor treatment safely.