Laparoscopic treatment of Amyand-like hernia: a rare case report and literature review.

Introduction and importance: Amyand's hernia (AH) is defined by the anatomical presence of the vermiform appendix within the inguinal hernial sac. Meanwhile, extraperitoneal appendix cases remain exceptionally rare. This report details a unique case of an indirect inguinal hernia with an extraperitoneal appendix from the anterior abdominal wall, which exhibited firm adhesion to the lateral hernial sac wall. We have tentatively designated this morphological variant as "Amyand-like hernia (ALH)" and discuss the management strategies and surgical implications. Presentation of case: We describe a 70-year-old male diagnosed with a right-sided indirect inguinal hernia. Intraoperative exploration revealed an extraperitoneal appendix located in the anterior abdominal wall, demonstrating firm adhesion to the hernial sac. Following AH management guidelines, laparoscopic tension-free mesh hernioplasty with concurrent appendectomy was performed, given the anatomical adhesion complexity and absence of acute inflammation. The postoperative course was uncomplicated, with discharge occurring on postoperative day 2. Clinical surveillance at 60 days postoperatively confirmed complete recovery without evidence of recurrence or surgical site complications. Clinical discussion: This case report examines the distinctions between AH and ALH, highlighting the challenges associated with the management of ALH. The successful surgical interventions underscore the critical importance of prompt diagnosis and management. Conclusion: To our knowledge, this is the first reported case of an indirect inguinal hernia with an extraperitoneal appendix, adherent to the lateral hernial sac wall and extending into the inguinal canal. This case aims to broaden the understanding of hernias and contribute to the refinement of hernia classification and management.