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Appendicitis in paraumbilical hernia mimicking strangulation: a case report and review of the literature.
MedLine Citation:
PMID:  23708684     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: The contents of umbilical or paraumbilical herniae are usually omentum or bowel; rarely, metastatic deposits, appendix epiploicae, or an inflamed vermiform appendix may be found. Unexpected contents cause confusion in the diagnosis, especially when inflamed, and may mimic a strangulated umbilical hernia. Appendicitis in the hernial sac is known in inguinal and femoral herniae; however, only four reported cases of appendicitis within an umbilical hernia could be identified. CASE: A 54-year-old female presented to the emergency with a 2-day history of vomiting, severe pain and irreducibility of a paraumbilical swelling. On examination, we found tachycardia, with a tender, erythematous and irreducible paraumbilical swelling. With a diagnosis of strangulated paraumbilical hernia, the abdomen was explored through an infraumbilical incision. Opening the sac revealed inflammatory fluid, omentum, and an inflamed and edematous appendix. Appendicectomy was performed with anatomical double-breasted repair of the fascial defect. Histopathological examination of the specimen revealed acute appendicitis, periappendicitis and panniculitis in the omentum. CONCLUSION: Appendiceal inflammation inside a hernia sac is probably due to extrinsic compression and partial ischemia. Symptoms manifest late, and the final diagnosis is mostly made during the operation. CT scan provides only indirect clues to diagnosis. Appendicectomy and anatomical repair is the appropriate treatment for appendicitis within a paraumbilical hernia.
Authors:
N Agarwal; S Goyal; A Kumar; A Garg; N Kaur; A Gupta
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-26
Journal Detail:
Title:  Hernia : the journal of hernias and abdominal wall surgery     Volume:  -     ISSN:  1248-9204     ISO Abbreviation:  Hernia     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-5-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9715168     Medline TA:  Hernia     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Surgery, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, 110095, India, drnitinagarwal76@gmail.com.
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