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Introduction: The finding of a vermiform appendix within the peritoneal sac of an indirect inguinal hernia occurs in approximately 1% of cases. However, the presence of appendicitis within an inguinal hernial sac is found only in 0.08% of the general population.Case report: We present the case of a 58-year-old male patient that was admitted with abdominal pain associated with a small non-reducible right groin mass.Discussion: To establish the correct diagnosis preoperatively, an abdominal and pelvic CT scan is mandatory.Conclusion: Acute appendicitis in an Amyand's hernia is a very rare entity that can be easily misdiagnosed preoperatively. CT is extremely useful in reaching the correct preoperative diagnosis.

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Background The finding of a vermiform appendix within the peritoneal sac of an inguinal hernia is called Amyand’s hernia. The reported incidence of Amyand’s hernia and femoral hernia is 1% and 3.8%, respectively. To our knowledge, no cases have been reported in the literature that associate these two entities. We present the first case of incarcerated left-sided Amyand’s hernia and synchronous ipsilateral femoral hernia found during emergency surgery. Case presentation A 72-year-old woman was admitted to the Emergency Department for a complicated left inguinal hernia. An inguinotomy was performed that detected a large direct hernial sac and a synchronous femoral hernia. The opening of the inguinal hernia showed the presence of the cecum and the appendix, both without signs of inflammation. The femoral space was evaluated transinguinally, identifying the larger omentum that had slipped into the femoral canal. The primary closure of the posterior wall defect was performed with the McVay technique due to its large size, and then the hernioplasty was completed with a polypropylene mesh. No postoperative complications were reported. Conclusions In the context of an incarcerated Amyand’s hernia, the decision to perform an appendectomy in addition to hernia repair with or without mesh will depend on intraoperative findings.

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