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INTRODUCTION: Amyand's hernia (AH) is a rare condition in which the vermiform appendix is incarcerated within the inguinal hernia (IH) sac. Although infrequent, it may become inflamed or perforated and can typically be diagnosed either intraoperatively or through radiographic findings. PRESENTATION OF CASE: A 77-year-old male presented to the emergency room with constipation, fever, and an irreducible right inguinal bulge accompanied by slight localized discomfort that had persisted for ten days. Clinical examination was unremarkable, while ultrasound revealed a non-ischemic small bowel loop and a right testicular hydrocele, leading to a primary diagnosis of incarcerated IH. The patient was subsequently admitted for surgery, during which AH was confirmed. The appendix was inflamed, enlarged, and perforated, with localized abscess and internal inguinal ring stenosis. Subsequently, the surgical treatment involved appendectomy and hernia repair. DISCUSSION: According to the appendix condition, four subtypes of AH can be encountered, with type III -perforated appendicitis- being the focus of this report. In this case report, inguinal ring stenosis was the underlying cause of complications besides the unusual presentation features that were also attributed to adhesions that prevented peritoneal involvement. CONCLUSION: Surgeons should consider AH in the differential diagnosis of inguinal swelling and be familiar with the surgical management approach in the incidental event of AH during surgery.
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INTRODUCTION AND IMPORTANCE: De Garengeot hernia is a rare case of a femoral hernia. It occurs when a femoral hernia contains a vermiform appendix that may be inflamed and sometimes necrotic, and this requires emergency surgery. However, the hernia is usually discovered by chance in the operating theater, which poses an additional challenge for surgeons. CASE PRESENTATION: A 64-year-old man presented with a 1-week history of a painful right groin lump. The lump is irreducible and painful on exert a week ago. Ultrasound imaging showed a 1.5 × 2 cm loculated turbid liquid collection containing an edematous intestinal loop measuring 8 mm in diameter that was suspected to be the vermiform appendix. Therefore, appendectomy was performed through the hernia sac. After that, the hernia was repaired using the McVay technique and 2.0 nylon sutures. One day after the operation, the patient was discharged, and he returned to the clinic after 10 days without any complications. CLINICAL DISCUSSION: The patient has a history of chronic obstructive pulmonary disease (COPD), which is a risk factor for a hernia. He had to live with the right femoral hernia for ten years until it became painful and irreversible. Ultrasound revealed what appears to be an appendix. To avoid possible consequences of complicated appendicitis and strangulated hernia, emergency surgery was the appropriate choice for our patient case. CONCLUSION: The presence of an appendix in the femoral hernia poses a diagnostic and therapeutic challenge to surgeons, due to the atypical clinical picture and the lack of efficacy of radiographic methods in diagnosing the condition.
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Introduction: and importance: Acquired small bowel diverticulosis is rare 1% and the ileum is the less frequent occurring site 15%. Most cases were multiple and asymptomatic. This is the first case of perforated terminal ileum diverticula in a 32-year-old woman and successfully managed surgically. Case presentation: We describe a rare case of terminal ileal diverticulosis, one of the diverticula was perforated, in a 32-year-old female who presented with a 2-days history of sudden epigastric and periumbilical pain and had been managing surgically. At surgery, we found multiple diverticula, one of them was perforated. Microscopically, the specimen confirmed that the diagnosis was diverticulosis. Conclusion: Diverticulosis should be included in the differential diagnosis of a sudden epigastric and periumbilical pain even in this age.
