Zouki Jason, Dharmawardhane Anoj
General Surgery, Toowoomba Hospital, Toowoomba, AUS.
Cureus. 2024 Feb 25;16(2):e54894. doi: 10.7759/cureus.54894. eCollection 2024 Feb.
Amyand's hernia (AH) describes the rare instance of a vermiform appendix within an inguinal hernia. Primary appendiceal neoplasms are also rare with the majority of cases being found incidentally during routine histopathology. This case reports the management of a 15-year-old male, who presented to the emergency department with acute appendicitis located within an indirect right inguinal hernia, which was ultimately secondary to a neuroendocrine tumor (NET) with serosal involvement. Intraoperative findings included macroscopic appendicitis with no evidence of perforation. Histopathology returned as a neuroendocrine tumor (pT4) with involved proximal margin and curative treatment was undertaken with a caecectomy which returned no residual malignancy. Key considerations include management options of peritoneal spread within the inguinal canal and recommended management NET in the context of an AH. It is important to understand the varied presentations of common surgical diagnosis such as appendicitis and underlying malignancy should always be considered a differential.
艾米安德疝（AH）指的是腹股沟疝内出现阑尾这一罕见情况。原发性阑尾肿瘤也很罕见，大多数病例是在常规组织病理学检查时偶然发现的。本病例报告了一名15岁男性的治疗情况，该患者因间接性右侧腹股沟疝内的急性阑尾炎就诊于急诊科，最终发现是由神经内分泌肿瘤（NET）伴浆膜受累所致。术中发现包括肉眼可见的阑尾炎，无穿孔迹象。组织病理学结果为神经内分泌肿瘤（pT4），近端切缘受累，遂行盲肠切除术进行根治性治疗，术后未发现残留恶性肿瘤。关键考虑因素包括腹股沟管内腹膜播散的处理选择以及AH背景下NET的推荐治疗。了解常见外科诊断的不同表现很重要，如阑尾炎，并且始终应将潜在恶性肿瘤视为鉴别诊断。
