Acute appendicitis masquerading as strangulated para-umbilical hernia

A case of 35 year old male who presented with cellulitis of the skin overlying a previously diagnosed incarcerated para-umbilical hernia. Initially it was thought to have resulted from vigorous scratching but the changed clinical picture of the patient, while under observation, necessitated the revision of the diagnosis to strangulated para-umbilical hernia is reported. On exploration an acutely inflamed appendix along with some omentum was found to be the content of the hernia and responsible for the cellulitis. Such a mode of presentation of appendicitis has not been reported previously