A Case of Amyand Hernia with Early Postoperative Abscess Formation from a Fistula to the Cecum following Laparoscopic Inguinal Hernia Repair

Abstract

A 60-year-old man presented with right inguinal swelling. The patient was diagnosed with an Amyand hernia classified as JHS L3 (Losanoff Type 1) and underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair. The patient developed redness, swelling, and localized heat in the right inguinal region on postoperative day 25. A CT scan revealed fluid collection with septation, leading to the diagnosis of a preperitoneal abscess following TAPP. Abscess drainage and mesh removal were then performed. Intestinal fluid leakage from the abscess drainage site was observed postoperatively, and a CT scan showed that the drain had migrated into the cecal lumen. Consequently, a fistulectomy and ileocecal resection were performed, and the patient was discharged on postoperative day 21. The presence of enteric bacteria in the abscess culture and intraoperative findings of strong adhesions between the ileocecal region and fistula site, with the appendix being unidentifiable, suggested that mechanical stimuli during TAPP, such as traction and thermal injury from electrocautery, induced inflammation in the appendix and surrounding tissues. This led to preperitoneal abscess formation. Initial appendectomy followed by staged hernia repair could be a safer and more effective approach to prevent such complications in Amyand hernia repair.