existence of non - inflamed or inflamed vermiform appendix in an inguinal hernia is named amyand 's hernia in honor to the surgeon claudius amyand who successfully performed first perforated appendicitis .
a 69-year - old turkish male patient with a slight right groin pain and swelling was presented to our clinic , and found to have a slightly tender and reducible right inguinal hernia .
he underwent surgery under general anesthesia , and a adhesive caecum and an inflamed appendix were explored within the hernia sac .
adhesions were divided by sharp dissection and appendectomy was performed . after carrying out a lichtenstein hernioplasty ,
he recovered uneventfully , and neither complication nor recurrence was detected during 52 months of follow - up .
although occurrence of an appendicitis in an inguinal hernia is rare , a surgeon should be vigilant for facing with it even in elective cases .
treatment can be provided only surgically , but surgical treatment is not standard except from appendectomy . in our opinion ,
application of mesh hernia repair should depend on the degree of inflammation of appendix and the presence of incarceration of hernia sac with a suitable antibiotic admission for 3 - 5 days postoperatively .
claudius amyand ( 1660 - 1740 ) , also known as  surgeon - in - ordinary  or  sergeant surgeon  to king george ii of england , defined an acutely inflamed appendix located in the inguinal canal in an 11-year - old boy on 6 december 1735 .
then he treated himself by an appendectomy , which is the first recorded successful appendectomy in the world .
actually , he described an appendicitis in the inguinal canal ( later , it is named as amyand 's hernia ) , and performed first successful appendectomy at the same time in 1735 .
the surgeon defined the operation as  most complicated and perplexing  , and pathology revealed a chronically inflamed appendix included within the inguinal hernia sac and perforated by a previously swallowed pin .
after the successful appendectomy ,  so much of hernia bag had been detached from the skin  .
the boy recovered uneventfully and  discharged with a truss , he was ordered to wear it for some time , to confirm cure . 
this case was published in philosophical transactions of the royal society of london . in the present report
, we purposed to present a rare case of inguinal hernia consisting the appendicitis and adhesive caecum in a 69-year - old man .
a 69-year - old turkish man presented with slight right groin pain and swelling , but did not complain about nausea , vomiting or abdominal pain . on the physical examination , a slightly tender and reducible right inguinal hernia was detected .
it was no abnormality except for a minimal tenderness at the right lower quadrant of the abdomen .
the mobile bowel was observed inside the right inguinal channel and the scrotum , but no any mass or abnormality was detected in the testes in the preoperative scrotal ultrasonography . at the operation ,
an adhesive caecum and an inflamed appendix with appendiceal fecalith were explored within the hernia sac ( figure 1 ) . a drawn image of an adhesive caecum and an inflamed appendix with an appendiceal fecalith within the sac of right inguinal hernia after splitting the sac perioperatively .
. then an appendectomy was performed , and the remnant stump and caecum were brought back into the abdominal cavity .
the hernia repair was achieved by carrying out a lichtenstein hernioplasty using prolene mesh and prolene sutures .
however , the congestion and focal lenfocytic infiltration was seen in serosal portion of the appendix ( figure 2 ) .
although mucosal and submucosal part was in normal histological appearance , congestion and focal lenfocytic infiltration was seen in serosal portion of the appendix ( haematoxylin & eosin , original magnification , 100 ) .
the probability of a person to have the disease of acute appendicitis in her / his life is 8% , and occurrence of an asymptomatic appendix within an hernia sac is a rare entity accounting for 1% .
however , the incidence of an acute appendicitis in a sac of inguinal hernia is an even less common , it is about 0.13% [ 24 ] .
ryan   reported in 1937 that 11 of 8692 cases ( 0.13 % ) of appendicitis were located in external hernia sacs .
thomas et al   reported only 7 acute appendicitis occurring in an external hernia sac during 8 years .
however , ages of that kind of cases ranges from 3 weeks to 88 years .
the incidence of acute appendicitis in an hernia sac is reported between 0.008% and 1% in the english - language literature .
an inflamed appendix is an emergency condition . in the case of amyand 's hernia ,
nonetheless , to our knowledge , weber   is the unique surgeon who suggested that he was detected it preoperatively . in the evaluation of groins and scrotum
similarly , ultrasound imaging did not give additional information preoperatively except for the exhibition of the sliding hernia in the present case .
strangulated hernia , strangulated omentocele , acute hydrocele , richter 's hernia , testicular tumor with hemorrhage , inguinal adenitis , and epidydimitis may be concerned in the differential diagnosis of amyand 's hernia .
appendectomy through the herniotomy with primary hernia repair using the same incision is used for the treatment of hernial appendicitis . in the presence of appendix vermiform in the sac of hernia ,
however , in case of inflamed appendix in the sac , appendectomy without mesh hernia repair is suggested by some authors .
nonetheless , some prefer to perform both appendectomy and mesh hernia repair in the treatment of inflamed appendix in the inguinal hernia sac , and they recommended the intravenous broad - spectrum antibiotics for at least 3 - 5 days to prevent a possible mesh infection .
additionally , torino et al   irrigated the inguinal area with antibiotics . in our case , even if the appendix was congested and inflamed with an adhesive caecum inside the sac , the sac was not incarcerated and no any abscess was observed .
therefore , we performed an appendectomy with mesh hernia repair , did not irrigate the inguinal area with antibiotics , and postoperatively admitted an intravenous broad - spectrum antibiotic for 3 days .
the appendicitis within an amyand 's hernia is rare , but misdiagnosis is not seldom when it occurs .
although it can be treated by surgery only , surgical treatment is not standard except from appendectomy . in our opinion ,
application of mesh hernia repair should depend on the degree of inflammation of appendix and the presence of incarceration of hernia sac .
awareness of this condition would be helpful in the preoperative diagnosis of both exigent and elective cases .
 context : existence of non - inflamed or inflamed vermiform appendix in an inguinal hernia is named amyand 's hernia in honor to the surgeon claudius amyand who successfully performed first perforated appendicitis.case report : a 69-year - old turkish male patient with a slight right groin pain and swelling was presented to our clinic , and found to have a slightly tender and reducible right inguinal hernia . 
 he underwent surgery under general anesthesia , and a adhesive caecum and an inflamed appendix were explored within the hernia sac . 
 adhesions were divided by sharp dissection and appendectomy was performed . after carrying out a lichtenstein hernioplasty , 
 a broad - spectrum antibiotic was postoperatively admitted for 3 days . 
 he recovered uneventfully , and neither complication nor recurrence was detected during 52 months of follow-up.conclusions:although occurrence of an appendicitis in an inguinal hernia is rare , a surgeon should be vigilant for facing with it even in elective cases . 
 treatment can be provided only surgically , but surgical treatment is not standard except from appendectomy . in our opinion , 
 application of mesh hernia repair should depend on the degree of inflammation of appendix and the presence of incarceration of hernia sac with a suitable antibiotic admission for 3 - 5 days postoperatively . 