Amyand's hernia presented with strangulated and perforated appendicitis: A case report

INTRODUCTION

Amyand's hernia (AH) is a rare condition in which the vermiform appendix is incarcerated within the inguinal hernia (IH) sac. Although infrequent, it may become inflamed or perforated and can typically be diagnosed either intraoperatively or through radiographic findings.

PRESENTATION OF CASE

A 77-year-old male presented to the emergency room with constipation, fever, and an irreducible right inguinal bulge accompanied by slight localized discomfort that had persisted for ten days. Clinical examination was unremarkable, while ultrasound revealed a non-ischemic small bowel loop and a right testicular hydrocele, leading to a primary diagnosis of incarcerated IH. The patient was subsequently admitted for surgery, during which AH was confirmed. The appendix was inflamed, enlarged, and perforated, with localized abscess and internal inguinal ring stenosis. Subsequently, the surgical treatment involved appendectomy and hernia repair.

DISCUSSION

According to the appendix condition, four subtypes of AH can be encountered, with type III -perforated appendicitis- being the focus of this report. In this case report, inguinal ring stenosis was the underlying cause of complications besides the unusual presentation features that were also attributed to adhesions that prevented peritoneal involvement.

CONCLUSION

Surgeons should consider AH in the differential diagnosis of inguinal swelling and be familiar with the surgical management approach in the incidental event of AH during surgery.

A rare case of ruptured appendiceal diverticulitis: A significant surgical pathology

Appendiceal diverticulitis is a rare pathology which is distinctly different to acute appendicitis and associated with higher rates of morbidity and mortality. Furthermore, diagnosis is often retrospective on histopathological analysis of appendicectomy specimens due to the atypical clinical and radiological features. Herein, we present a case of ruptured appendiceal diverticulitis in a young patient with atypical clinical features and a radiologically normal appearing appendix in close proximity to an inflammatory phlegmon. This case highlights the importance of maintaining a high clinical suspicion of surgical pathology and considering atypical diagnosis in patients with inflammatory changes in the right iliac fossa.

An incidental finding of Rapunzel syndrome in a case of perforated appendix in a young girl

A bezoar is a mass of indigestible foreign material found in the gastrointestinal tract, usually in the stomach. Trichobezoars are the second most common bezoars which are usually found in young psychiatric patients. A 15-year-old female patient presented with signs of intestinal obstruction and acute abdomen. The preoperative investigations revealed a perforated appendix, and an exploratory laparotomy was performed. Intraoperative findings showed presence of a mass of hair in the stomach along with a long tail extending into the small intestine. Postoperatively, the patient's condition worsened and she died because of complications of perforation peritonitis on day 3. Early diagnosis of Rapunzel syndrome can help in making early interventions. The prognosis of incidental detection of this condition depends on the accompanying cause.

C-Reactive Protein: An Aid For Diagnosis Of Acute Appendicitis

BACKGROUND

Delayed or wrong diagnosis of acute appendicitis in patients results in complications like perforation, gangrene, etc. which carries a significant amount of morbidity and mortality to the patients. Thus, timely diagnosis of acute appendicitis is crucial to prevent these complications. Recently, it was found that serum C-reactive protein (CRP) individually can be a useful marker, thus in resource limited settings (i.e., access to ultrasonography) simple laboratory investigation can be of extreme utility for the diagnosis of acute appendicitis. Current study aimed to ascertain and determine the role of C Reactive Protein (CRP) as a complementary test to decrease the rate of negative appendectomies in tertiary care hospitals of Pakistan.

METHODS

Using non-probability consecutive sampling, 112 patients with the initial diagnosis of acute appendicitis on history and clinical examination were enrolled. A blood sample was taken for serum level of CRP.

RESULTS

Mean age was 20.8±8.6 years and 51 (45.5 %) patients were males. Pathologic review revealed 100 cases (89.3%) of acute appendicitis, 4 patients (3.6%) had perforated appendix while 8 patients (7.1%) had normal appendix. Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of C reactive protein >24 mg/lit taking histology as gold standard came out 25.9%, 100%, 100%, 9.4% and 31.25% respectively.

CONCLUSIONS

It was concluded that CRP >48 mg/lit is an indication of perforated appendix and when the surgeon is in fix whether to go conservatively or apply some intervention, CRP can be a good diagnostic aid.

A complicated case of amyand's hernia involving a perforated appendix and its management using minimally invasive laparoscopic surgery: A case report

INTRODUCTION

Amyand's hernia is a rare condition of inguinal hernia in which the appendix is incarcerated within the hernia sac through the internal ring. Complications include acute appendicitis and perforated appendicitis, which are rare in incidence, accounting for about 0.1% of cases.¹ These complications prove a diagnostic challenge due to their vague clinical presentation and atypical laboratory and radiological findings. Until recently, open appendectomy was the mainstay of treatment. Laparoscopic surgery offers a less invasive approach to confirming a diagnosis and serving as a therapeutic tool in equivocal cases.

CASE PRESENTATION

We report a case of a previously healthy 20-year-old male presenting with atypical signs and symptoms, as well as blood investigation results, and radiological findings of a perforated appendix within an Amyand's hernia. The patient was successfully managed using a minimally invasive laparoscopic appendectomy approach.

DISCUSSION

Until recently, open appendectomy was considered the mainstay in the management of complicated Amyand's hernia. Laparoscopic surgery provides a new avenue for dealing with diagnostic uncertainty with advantages including faster recovery time, reduced hospital stay, and better quality of life.

CONCLUSION

This case report highlights the concealing effects of an Amyand's hernia on a perforated appendix, the considerations required when an equivocal diagnosis present and the safe use of the minimally invasive laparoscopic surgery in the treatment of this rare condition.

Perforated Appendicitis with Peri-Appendicular Abscess in an Amyand's Hernia

Amyand's hernia is a rare clinical condition in which a normal or an inflamed appendix lies in the inguinal hernial sac. Perforated appendicitis in an Amyand's hernia is even more uncommon. Herein we report such a rare case in a 4 month old baby who presented with an irreducible right inguino-scrotal swelling. Exploration revealed perforated appendix in the hernial sac with local abscess. A transherniotomy appendectomy was done. Postoperatively, the patient developed wound infection, which resolved with wound care. Pediatric / hernia surgeons must remember this rare clinical situation while managing children with acute right inguino-scrotal swellings.