Hernia (2012) 16:91–97 DOI 10.1007/s10029-010-0715-7 123 CASE REPORT An incarcerated appendix: report of three cases and a review of the literature Rikki Singal · Amit Mittal · Anupama Gupta · Samita Gupta · Pradeep Sahu · Manmit Singh Sekhon Received: 5 May 2010 / Accepted: 23 July 2010 / Published online: 26 August 2010  Springer-Verlag 2010 Abstract We came across three rare cases of incarcerated hernia, with diVerent presentations. The Wrst case was an elderly female, who presented with an incarcerated inci- sional hernia on the right lower iliac region diagnosed on contrast enhanced computed tomography (CT); the con- tents were the small bowel and the perforated tip of the appendix. In the second case of inguinal incarcerated her- nia, ultrasonography showed the inXammed appendix in the subcutaneous plane of the hernial sac, which is very rarely diagnosed pre-operatively and was conWrmed during sur- gery. InXammed appendix with gangrenous tip was found in the inguinal hernial sac. In yet another case of incarcer- ated inguinal hernia, the contents were a gangrenous part of the ascending colon and transverse colon, with the tip of the inXamed appendix—also only rarely observed. The colon extended to the scrotum in this case. We could Wnd no description within the existing medical literature on either transverse or ascending colon as contents in inguinal hernia although transverse colon alone has been reported in four cases. The surgical options for dealing with the appendix in an Amyand’s hernia depend on the mode of presentation. The presence of a normal appendix does not require an appendicectomy to be performed, but its removal is neces- sary if inXamed. Keywords Obstruction · Inguinal · Incisional · Hernia · Iliac bone graft · Ultrasonography Introduction The incidence of appendicitis within an inguinal hernia is rare, estimated at 0.07–0.13% [1]. Acute appendicitis is the most frequent cause of acute right iliac fossa pain. The presence of the perforated tip of the appendix in incisional hernia at the site of iliac bone graft, as seen in our Wrst case, is extremely rare. The eponym Amyand hernia was Wrst suggested by Creese in 1953, then by Hiatt and Hiatt in 1988 followed by Hutchinson in 1993, in recognition of Claudius Amyand, a British surgeon who performed the Wrst successful appendicectomy in a hernial sac in 1735 [2–6]. It is very rare to diagnose an in Xammed appendix in incarcerated inguinal hernia on ultrasonography (USG) These cases are done in Gian Sagar Medical College & Hospital (Department of Surgery), Ram Nagar, Banur, Punjab, India. R. Singal · M. S. Sekhon Department of Surgery, Gian Sagar Medical College & Hospital Member of ASI-15440, Ram Nagar, Banur, Punjab 140401, India e-mail: singalrikki@live.com A. Mittal Department of Radiology, M. M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana 13303, India e-mail: amitmittalmri@gmail.com A. Gupta Department of Anatomy, Adesh Institute of Medical Science & Research, Bathinda, Punjab, India S. Gupta Department of Radiodiagnosis, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana 13303, India e-mail: singalromy@yahoo.com P. Sahu Department of Surgery, M. M. Institute of Medical Sciences and Research, Mullana, Ambala, Punjab 140401, India e-mail: drpradeepkumarsahu@gmail.com R. Singal (&) C/o Kundan Lal Hospital, Ahmedgarh, Sangrur, Punjab 148021, India e-mail: singalrikki@yahoo.com; singalrikki@ymail.com