A rare presentation of appendicitis inside the femoral canal: case report and literature review.

BACKGROUND: Femoral hernia accounts for 3% of all the hernias, and in 0.5-5% of cases, the appendix can migrate through the femoral hernia and is called de Garengeot hernia. It is a very rare condition, and the incidence of appendicitis in this type of hernia is as low as 0.08-0.13%. CASE PRESENTATION: We bring into discussion a case of a 47-year-old female who presented to the emergency department with a painful right-sided groin lump for the past 2 days. After initial resuscitation, a CT scan was requested which showed the presence of inflamed appendix inside the femoral canal. She was taken to the operative theatre, and during the laparoscopy, the appendix was identified migrating through the femoral canal and it could not be retracted into the peritoneal cavity; therefore, the mesoappendix was divided and the operation converted to the open low approach. After identifying the femoral hernia sac and opening it, the appendix was removed and herniorrhaphy was performed. Our patient had an uneventful recovery and was discharged on the following day. CONCLUSION: We report a rare case of de Garengeot hernia which was diagnosed preoperatively. Because of its non-specific presentation, patients are usually diagnosed with incarcerated femoral hernia and are taken to operative theatre and the final diagnosis is made intra-operatively. Due to its rarity, there is no standard approach for this condition, and emergency appendicectomy and concurrent herniorrhaphy is the mainstay of treatment. In this paper, we present different surgical methods for the treatment of this type of hernia.

Intraperitoneal explosion following gastric perforation.

The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.

Small bowel perforation caused by a retained percutaneous endoscopic gastrostomy tube flange.

A method used at some centers to remove or replace percutaneous endoscopic gastrostomy tubes is to cut the tube at the skin level, allowing the internal flange to be eliminated intestinally. This is known as the cut-and-push technique. This report describes a case in which the internal flange resulted in intestinal perforation in a patient with no history of underlying intestinal disease or abdominal surgery. This case illustrates the importance of interval abdominal radiographs to confirm extrusion of the internal flange.

A "paneful" perforation.

Radiographs of a woman presenting with abdominal pain revealed a large foreign body within the pelvis. A diagnosis of perforation of the colon was made, and at laparotomy an 8.5 cm long glass fragment was removed from the bowel. A laceration to the lower back, sustained in a fall onto a glass coffee table, had been explored and sutured 20 months earlier. Imaging findings showed the subsequent course of the overlooked glass fragment within the pelvis.

Percutaneous gelfoam embolization of chronic enterocutaneous fistulas: report of three cases.

PURPOSE: A relatively simple radiologically guided method for the treatment of enterocutaneous fistula by gelfoam embolization is described. METHODS: Three cases of chronic enterocutaneous fistula are presented. In each case, a sheath was positioned with its tip at the enteric opening of the fistula. Gelfoam was injected to occlude the fistula at its enteric opening. RESULTS: In each case, there was successful closure of the fistula. CONCLUSIONS: Radiologically guided embolization with gelfoam is a safe, relatively simple procedure, which may be useful in the treatment of chronic enterocutaneous fistula.