ABSTRACT
Background: Amyand's hernia (AH) is a rare type of inguinal hernia, containing the appendix in the hernia sac irrespective of the presence of appendicitis. Appendiceal mucocele represents a dilation of the appendix with an accumulation of mucinous material and could be either a benign or a malignant process. Herein we report an exceptionally rare case of a perforated appendiceal mucocele within an AH. Case report: A 77-year-old male patient, underwent surgery for right incarcerated inguinoscrotal hernia. He was found to have a perforated, phlegmonous, and dilated appendix dislocated from the caecum, with peri-appendicular purulent content with fibrin deposits within the hernia sac. Also, the last ileal loop, caecum, ascendant colon, and the right testicle within the hernia sac, were compromised due to the septic process around. A right hemicolectomy and orchiectomy, followed by a herniorrhaphy without using a synthetic mesh, was performed. Histopathological examination revealed a perforated benign appendiceal mucocele associated with phlegmonous appendicitis and fibrinous peritonitis. Conclusions: This case report describes a rare combination of entities: an AH that presented as an incarcerated hernia and was diagnosed intraoperatively with a perforated, phlegmonous, and dilated appendix, proving to be an appendiceal mucocele.
ABSTRACT
BACKGROUND: Defunctioning stomas can prevent consequences of anastomotic leakage, but they are not free of complications. OBJECTIVES: The identification of high-risk patients to establish criteria for strong and relative indications for the formation of a defunctioning stoma. METHODS: Two hundred fifty consecutive colorectal anastomoses were performed between 2004 and 2015; 95.2% of these were for colorectal cancer. In 130 cases, mechanical anastomosis was used. A protective stoma was performed in only 15 cases. The incidence of anastomotic leakage was evaluated according to multiple parameters, as were the postoperative complications related to protective stomas. The outcomes were compared to those reported in the literature. RESULTS: Symptomatic anastomotic leakage occurred in six patients (2.4%) and resulted in four deaths. None of the patients with a protective stoma developed serious complications related to the colorectal anastomosis. However, serious ileostomy-related complications occurred in two cases (15.38%). CONCLUSIONS: Protective stomas should be used only according to the risk criteria of the patients. Strong indications are: anastomotic imperfections, anastomosis under tension, previous pelvic irradiation, ultralow anastomosis in patients older than 70 years, patients over 80 years, and significant co-morbidities.
