The appendix where you least expect it: Incarcerated Amyand's hernia - A case report.

INTRODUCTION: Amyand's hernia, defined as the presence of the appendix within an inguinal hernia sac, is a rare surgical entity that may present with nonspecific abdominal or groin pain. Diagnosis in the emergency department (ED) is challenging due to overlap with more common causes of right lower quadrant pain and groin masses. CASE PRESENTATION: A 34-year old female with a history of canal of Nuck cyst excision presented to the ED with three days of worsening right lower quadrant pain and a painful right groin bulge. Computed tomography (CT) and ultrasound imaging revealed an incarcerated right inguinal hernia containing the distal appendix with features concerning for strangulation. The patient underwent urgent operative management including laparoscopic appendectomy and open inguinal hernia repair with mesh. CONCLUSION: This case highlights the importance of maintaining a broad differential diagnosis for groin masses in adult females and demonstrates the value of early cross-sectional imaging in identifying rare but clinically significant pathology in the ED.