Umbilical Hernia Containing Appendicitis

Abstract

Umbilical hernia is a common cause for patient presentation to the surgeon, often on a nonemergent basis for a bulge at or lateral to the umbilicus but occasionally under emergency circumstances for pain or bowel obstruction when the hernia contents become incarcerated or strangulated. Risk factors for umbilical hernia include female gender, obesity, and ascites. A defect in the abdominal wall fascia at the umbilicus allows the preperitoneal adipose tissue, omentum, or small or large bowel to protrude through the defect. Rarely described is herniation of the appendix through an umbilical hernia, though appendix-containing femoral hernia (de Garengeot hernia) and appendix-containing inguinal hernia (Amyand hernia) are more common. There are 10 available case reports in the medical literature that describe an appendix-containing umbilical hernia; in this case report, we present the 11th case report of appendicitis within an umbilical hernia.

Hidden Treasure: Congenital Adhesions Necessitating an Alternative Approach to Laparoscopic Appendicectomy

“…Probert et al describe a case of appendicitis in an Amyand hernia in which the patient had down-trending inflammatory markers without treatment [ 6 ]. Sigley et al also describe a case of appendicitis in an umbilical hernia where the inflammatory markers were also normal [ 7 ].…”

The Role of Minimally Invasive Surgery in Appendectomy Within a Hernia

“…There are no typical presentations and the variety of signs and symptoms has been described as ranging from nausea, vomiting, abdominal distension, and an erythematous, painful umbilical swelling consistent with a strangulated hernia to abscess formation with concurrent pain in the right lower quadrant [ 13 ]. CT findings for this phenomenon have been reported as a hernial defect containing the appendix and bowel with intramural air density and possible abscesses, but with no signs of obstruction or distension [ 3 , 13 ].…”

“…An umbilical hernia containing an appendix has no eponym for it yet. Our literature search revealed only 11 available case reports describing an umbilical hernia containing an inflamed appendix [ 3 ]. While most authors believe in an open approach to incarcerated hernias, we describe the benefits of laparoscopy in this subset of patients.…”

Various unusual presentation of acute appendicitis in adult. A case series

“…2 Herniation of appendix through umbilicus is extremely uncommon only 10 such cases are available in medical literature. 3 Acute appendicitis is an uncommon gastrointestinal disease in the elderly. When it strikes an older patient, the presentation usually is atypical.…”