Amyand’s hernia is defined as the presence of the vermiform appendix within an inguinal hernial sac. Less than 1 % of the world medical publications on hernias address this disease, out of which very few come from Latin America and the Caribbean. This is the case of a 78-year-old male patient who experienced signs and symptoms for approximately five months. He felt a lump in the right inguinal region which progressively increased in size. Two days prior to admission to the intensive care unit, he said his pain level was 8/10. During the right inguinal approach, the hernial sac was opened, revealing parts of the right colon, cecum and appendix with edematous changes. Therefore, the patient underwent an appendectomy and repair with polypropylene mesh.

Herniation is one of the most frequent surgical conditions. However, the presence of a megaureter in the hernia sac or content is extremely rare. Little has been reported on this topic in the world literature, and its diagnosis has been incidentally reached either as an intraoperative finding or during different contrast imaging studies. This is the clinical case of a patient with a history of inguinal hernia who underwent a herniorrhaphy 20 years ago and presented to the emergency department with a diagnostic impression of a relapsed hernial defect. He also had poorly-controlled diabetes mellitus. During his hospital stay, a diagnosis of relapsed hernia sac containing a megaureter was confirmed, and visceral-parietal adhesions and a subhepatic cecum were found.