A rare case of Amyand's hernia presenting as an enterocutaneous fistula.

The finding of the vermiform appendix in an inguinal hernia has an incidence of approximately 1%. The condition is given the eponymous name Amyand's hernia. However in just 0.08% the condition is complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix and is most often misdiagnosed as an incarcerated inguinal hernia. As such it is rarely recognised prior to surgical exploration. We report a case of Amyand's hernia in an 85 year old woman, which presented as a right groin enterocutaneous fistula. CT scanning illustrated a fistulous tract in the right groin, which communicated with the caecum and the peritoneal cavity. She underwent laparotomy, which revealed that the appendix appeared inflamed, lay in the inguinal canal and was the origin of the enterocutaneous communication.

Laparoscopic Appendicectomy.

Acute appendicitis is a common condition, accounting for substantial number of hospital days in all institutions and giving rise to considerable adverse economic and social consequences in the postoperative period. Laparoscopic appendicectomy offers several advantages over the open procedure. Diagnostic accuracy is improved. Postoperative morbidity, in particular wound infection, is reduced, as is postoperative pain, and cosmesis is improved. Discharge from hospital is hastened, as is return to normal activity and work. Surgical technique is detailed, including the approach to specific clinical scenarios such as perforated and retrocaecal appendicitis. The utilization of ultrasonically activated dissection for laparoscopic removal of the appendix is explained. The implications of laparoscopic appendicectomy for surgical training are discussed.