Department of Visceral Surgery, Geneva University Hospital, Geneva, Switzerland.
Department of Radiology, Geneva University Hospital, Geneva, Switzerland.
Am J Case Rep. 2023 Nov 29;24:e941649. doi: 10.12659/AJCR.941649.
BACKGROUND Amyand hernia is a rare condition described as the presence of the appendix within an inguinal hernia. The clinical presentation of can be atypical, depending on the length of the defect's history and the size of the hernia. As inguinal hernia repair is considered a routine surgical procedure, giant hernias are mostly encountered in countries with limited medical care or with patient rejection of surgical management. CASE REPORT We report a case of a 56-year-old patient with a history of a chronic giant inguinal-scrotal hernia for more than 10 years who presented himself to the Emergency Department with acute pain in the scrotum and fever. Computed tomography revealed a perforated appendicitis located in the inferior part of the scrotum. The patient underwent a surgical procedure with an inguinal and middle laparotomy approach, revealing a full incarceration of the right and traverse colon, terminal ileal loop, and omentum, along with evidence of a perforated appendicitis. Standard appendectomy and direct hernia repair were successfully performed. CONCLUSIONS To the best of our knowledge, this is the first case of a perforated appendicitis within a right giant inguinal hernia described in the modern English-language literature. Rare in our daily practice, giant hernias are a real challenge regarding their surgical management during and after surgery, making this case with a perforated appendicitis even more arduous.
Amyand 疝是一种罕见的疾病，其特征为阑尾位于腹股沟疝内。临床表现可能不典型，具体取决于疝缺陷的病史长短和疝的大小。由于腹股沟疝修补术被认为是一种常规手术，因此在医疗资源有限或患者拒绝手术治疗的国家，主要会遇到巨大疝。
我们报告了 1 例 56 岁患者，该患者患有慢性巨大腹股沟-阴囊疝超过 10 年，因阴囊急性疼痛和发热到急诊科就诊。计算机断层扫描显示位于阴囊下部的穿孔性阑尾炎。患者接受了腹股沟和中腹部剖腹手术，术中发现右侧和横结肠、末端回肠环和大网膜完全嵌顿，以及穿孔性阑尾炎的证据。成功进行了标准的阑尾切除术和直接疝修补术。
据我们所知，这是首例在现代英语文献中描述的右侧巨大腹股沟疝内穿孔性阑尾炎病例。在我们的日常实践中很少见，巨大疝在手术中和手术后的手术管理方面确实是一个挑战，使这种穿孔性阑尾炎病例更加困难。
