Appendicitis in paraumbilical hernia mimicking strangulation: a case report and review of the literature

Agarwal, Nitin; Goyal, Subhash; Kumar, Abdhesh; Garg, Ashish; Kaur, Navneet; Gupta, Arun

doi:10.1007/s10029-013-1118-3

Cited by 15 publications

(17 citation statements)

References 7 publications

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“…It can lead to abdominal lump, intraperitoneal and pelvic abscesses and peritonitis. There have been a few reports of finding a perforated appendix in inguinal and femoral hernias, but finding a perforated appendix in umbilical hernia is very rare [5]. In our present case the appendix had perforated through the umbilicus with inflamed omentum surrounding it and the caecum giving it an appearance of incarcerated hernia on ultrasonography.…”

Section: Discussionmentioning

confidence: 46%

Acute Perforated Appendix Mimicking Umbilical Hernia: A Rare Case Report

2016

J Clin Med Case Rep

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Section: Discussionmentioning

confidence: 46%

Acute Perforated Appendix Mimicking Umbilical Hernia: A Rare Case Report

2016

J Clin Med Case Rep

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“…To the best of our knowledge, there have been less than a handful of case reports in adults describing the presence of appendicitis within an umbilical or paraumbilical hernia sac. It was first described by Doig 4 in 1970, later by Al-Qahtanit 5 in 2003, and most recently by Agarwal 6 in 2013. All were single-patient case reports.…”

Section: Discussionmentioning

confidence: 99%

A Gut Feeling: An Extremely Rare Case of Missed Appendicitis

Pilgrim

Russo

Moulin

2014

WestJEM

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This case outlines the emergency department and surgical course of a 63-year-old male presenting with acute onset abdominal pain. Appendicitis was high on the differential for the treating physician, but after the computed tomography and laboratory evaluation were unremarkable, the patient was discharged only to return the next day. What ensued was one of the rarest cases of missed appendicitis documented in the medical literature.

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“…Agarwal et al . hypothesized that appendiceal inflammation inside an existing hernia sac may be caused by compression and partial ischaemia …”

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confidence: 99%

“…In terms of presentation, this is often later than for appendicitis within the peritoneal cavity. The patient presents with symptoms of pain in their hernia, usually without obstruction, and the presence of inflammation may not be obvious until the appendicitis is advanced . Meinke noted that presentations of appendiceal hernias correlate with symptoms typically seen in an incarcerated hernia such as a tender mass, and may lack the acute symptoms such as migratory pain, nausea and anorexia that one would typically expect in acute appendicitis.…”

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confidence: 99%

“…Agarwal et al . also noted in their review of appendicitis in existing umbilical hernias that symptoms typically manifest late, and that the final diagnosis is usually made in operating theatre . Another factor that contributes to a later presentation than would be expected for the degree of contamination present, is the containment of the contamination within the hernia sac, resulting in clinical signs of tenderness and guarding being localized to the hernia.…”

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confidence: 99%

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Complicated appendicitis within an incisional hernia

Becker

Woodfield

2018

ANZ Journal of Surgery

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A 71-year-old woman presented with 12 days of loose bowel motions and progressive swelling and pain associated with her right lower quadrant hernia. Her medical history included an acute high anterior resection with a covering loop ileostomy for perforated diverticular disease 3 years previously, followed by loop ileostomy closure 1 year later. She had noted a hernia at the ileostomy site for approximately 1 year, which was steadily increasing in size. On examination, she had a large erythematous incarcerated incisional hernia in the right iliac fossa. The hernia was tender, with localized guarding. The remainder of the abdomen was soft. Her white blood cell count was 27.0 × 10 9 /L, neutrophils 24.4 × 10 9 /L and her Creactive protein 289 mg/L. An abdominal computed tomography scan showed a large collection of extraluminal fluid and gas within the hernia with emphysematous infection involving the overlying skin (Figs 1-3). The findings were consistent with a perforation of either the appendix or the terminal ileum within the hernia.Surgery was performed through a transverse skin crease incision. The hernia sac was dissected out onto the fascia and then opened. There was heavy contamination of purulent fluid within the hernia sac, with the wall of the abscess cavity involving adjacent mesentery, small bowel and caecum. A necrotic perforated appendix was identified and removed. The necrotizing infection, which extended into subcutaneous tissues (Fig. 3) and overlying skin, was debrided. Due to heavy contamination, the fascial repair was performed with one polydioxanone suture without a mesh being placed. A vacuumassisted closure dressing was placed, which, as well as allowing the area to be drained, enabled us to preserve some of the overlying skin. Post-operatively she was treated with broad spectrum intravenous antibiotics. The pathology report confirmed acute appendicitis.

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Appendicitis in paraumbilical hernia mimicking strangulation: a case report and review of the literature

Cited by 15 publications

References 7 publications

Acute Perforated Appendix Mimicking Umbilical Hernia: A Rare Case Report

Acute Perforated Appendix Mimicking Umbilical Hernia: A Rare Case Report

A Gut Feeling: An Extremely Rare Case of Missed Appendicitis

Complicated appendicitis within an incisional hernia

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