Background: Localization of acute appendicitis in a hernia sac is a rare phenomenon with a frequency of around 0.08 - 1 %. Even fewer cases of postoperative hernias with a vermiform appendix in the hernia sac have been described. We selected 23 cases in the English literature describing this phenomenon and analyzed diagnostic and treatment options.
Case presentation: We present a 72-year-old woman who was complaining of a painful, rigid mass in the anterior abdomen wall for two days. After performing an ultrasound, incarcerated ventral hernia was diagnosed and emergency surgery was performed. During the surgery, gangrenous appendicitis was found in the hernia sac. It was decided to do an appendectomy and primal hernioplasty. Postoperative period was uneventful.
Conclusion: Appendicitis within incisional hernia is an extremely rare phenomenon. Diagnosis may be challenging because of dominating incarcerated hernia symptoms. However, computed tomography might play a crucial role, by differentiating causes of acute abdomen. Appendectomy is the standard option for appendicitis treatment, however, there is no consensus on how abdominal wall integrity should be restored.