title: First case of villous adenoma of the appendix leading to acute appendicitis presenting as strangulated femoral hernia: changes in management owing to concurrent adenoma.
abstract: A 78-year-old lady presented with signs and symptoms of a strangulated femoral hernia. Peri-operatively she was found to have appendicitis within the hernia sac. Appendicectomy and non-mesh hernia repair were performed. Histology revealed acute inflammation and a villous adenoma of the appendix. Villous adenomas of the vermiform appendix are extremely rare tumours of the gastrointestinal tract. This is the first case combining two very rare pathologies--acute appendicitis presenting as strangulated femoral hernia and villous adenoma of the appendix. Early diagnosis and surgery are required to avoid high morbidity of perforated appendicitis within a femoral hernia. First, we discuss the diagnosis and surgical treatment of acute appendicitis within a femoral hernia. Second, the presence of an adenoma changes the aetiology of appendicitis. More importantly, changes in surgical management of acute appendicitis presenting as a strangulated femoral hernia owing to a co-existing adenoma are discussed.
authors.affiliation: Academic Surgical Unit, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK. aravindsuppiah@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Suppiah
authors.forename: J
authors.initials: J
authors.lastname: Barandiaran
authors.forename: R
authors.initials: R
authors.lastname: Morgan
authors.forename: E P
authors.initials: EP
authors.lastname: Perry
mesh_terms: D018253:Adenoma, Villous / Q000150:complications* / Q000175:diagnosis; D000368:Aged; D001063:Appendiceal Neoplasms / Q000150:complications* / Q000175:diagnosis; D001064:Appendicitis / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D005260:Female; D006550:Hernia, Femoral / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans