Left para-umbilical incisional hernia appendicitis : a case report and a review of the literature

• Published in: Maġallat al-ṭibbiyat al-lubnāniyyat Vol. 67; no. 2; pp. 113 - 116
• Main Authors: Musa, Tania, Sabah, Mahmud, Sarraf, Dalia, Abu Ghazalah, Rim
• Format: Journal Article
• Language: English; French
• Published: Beyrouth, Liban Ordre des Medecins du Liban 01.04.2019
• ISSN: 0023-9852
• DOI: 10.12816/0054126

Background : Acute appendicitis is widely considered a surgical emergency. The herniation of an inflamed appendix is not common, it occurs in 0.13% of all appendicitis cases; it has been described in groin hernias as Amyand’s hernia referring to Claudius Amyand, the first surgeon who performed an appendectomy in 1735. Case report : We describe the case of a 65-year-old female with acute appendicitis situated in a left para-umbilical incisional hernia following a vertical caesarian section. Acute appendicitis was highly suspected preoperatively on computed tomography scan (CT scan) and confirmed intraoperatively. A concomitant severe right colitis was noticed along with localized peritonitis. A right hemicolectomy was performed with subsequent primary repair of the hernial defect. Discussion: Even if atypical herniated appendicitis constitutes a rare presentation, we should be aware of its complications and make an early assessment with CT scan when clinical signs are doubtful. The herniation of digestive contents through large defects caused by laparotomies is usually more frequent than through laparoscopic port sites. Defects should be repaired considering their size and the degree of contamination of the hernial sac. There is no consensus for mesh use in contaminated incisional hernias. The primary goal must remain, as in our case, treating the acute abdomen.