The presence of acute appendicitis in an incarcerated Amyand's hernia is rare, and the diagnosis is always made on the operating table. The clinical picture is similar to that of a strangulated hernia. We report an 81-year-old male patient with acute appendicitis in an incarcerated Amyand's hernia with the initial presentation of a worsening, painful mass over his right inguinal area. An emergent appendectomy through a herniotomy and herniorrhaphy was performed. An incarcerated hernia with appendicitis may occur without signs of a strangulated bowel and is hard to distinguish from other irreducible non-bowel strangulated masses. Unfortunately, delayed diagnosis and management may result in moresevere postoperative complications. In our opinion, an emergent operation is a better choice.