Acute appendicitis in an incarcerated crural hernia: analysis of our experience.
BACKGROUND
The finding of the vermiform appendix within a crural hernia (Amyand s hernia) is a rare entity whose incidence is not described in the literature.


OBJECTIVE
The aim of this study was to report our hospital s experience in this kind of pathology.


METHODS
Between 1993 and 2004, 4,572 acute appendicitis and 372 incarcerated crural hernia cases have been operated on in our hospital. We studied 6 cases of incarcerated crural hernia with vermiform appendix inside. We analyzed in retrospect the following parameters: age, sex, personal history, clinical manifestations, preoperative diagnosis, surgical technique, mean hospital stay, and outcome.


RESULTS
All patients were women with a mean age of 78.8 years. Most frequent clinical manifestations included pain and a mass in the right inguinocrural region, of variable intensity and duration. No clinical, laboratory, or radiographic signs help in reaching a correct preoperative diagnosis. General anesthesia and a crural approach are used in most surgical operations. In all cases an appendectomy was performed via the hernia sac, thus proving the presence of acute appendicitis in four of them (66.67%). A prosthetic mesh was used in 3 cases, and one case of wound infection was found. In the other cases we sutured the hernia ring using prolene.


CONCLUSIONS
The finding of the appendix in an incarcerated crural hernia is a rare entity in old women that is difficult to diagnose preoperatively. Treatment includes appendectomy and herniorraphy. The use of prosthetic mesh is controversial.
Priego
P
P
Department of General Digestive Surgery, Hospital Ramón y Cajal, Madrid, Spain. papriego@hotmail.com
Lobo
E
E
Moreno
I
I
Sánchez-Picot
S
S
Gil Olarte
M A
MA
Alonso
N
N
Fresneda
V
V
D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000150:complications* / Q000601:surgery; D005260:Female; D006550:Hernia, Femoral / Q000150:complications* / Q000601:surgery; D006801:Humans; D012189:Retrospective Studies