An Amyand hernia is an incarcerated inguinal hernia containing the appendix with or without appendicitis. This is a rare form of inguinal hernia, making up approximately 0.4%-1% of all cases. As with any hernia, this may become strangulated at any time, leading to the loss of blood supply and further development of gangrene and complications. Clinically, this can present in a manner indistinguishable from other types of inguinal hernias. In addition, the appendix can be affected by its own set of pathological processes, such as infection, inflammation, and malignancy. Not uncommonly both hernial and appendiceal complications coexist. The clinical diagnosis of an Amyand hernia remains challenging due to its low incidence and indistinct clinical presentation. At present, surgery is usually diagnostic and therapeutic. However, there is a growing number of recent reports showing the invaluable role of imaging on the diagnosis of Amyand hernias and associated complications. The correct and timely recognition of their imaging features including complications can optimize and expedite patient care by guiding diagnosis, treatment, and prognosis. Here, we report for the first time the radiological and pathological findings of a patient with a unique complicated Amyand hernia, which posed a diagnostic challenge for the clinical and radiological teams.