Gangrenous Appendicitis in Incarcerated Femoral Hernia

Tomo Osako, Tomohiko Usui*, Satoki Nishida* and Kouichi Shirono*

Department of Surgery, Ayabe Municipal Hospital
Department of Surgery, Maizuru Medical Center*

We report a rare case of acute appendicitis in a right femoral hernia. A 90-year-old woman admitted for right groin pain and swelling was found on palpation to have a 6-cm right inguinal mass. Pelvic computed tomography (CT) showed a tubular structure terminating as a blind wedge in the right femoral hernia. Emergency surgery showed gangrenous appendicitis and a periappendiceal abscess in the hernial sac. We completed inguinal exploration with peritoneal drainage, appendectomy, and herniorrhaphy via a MacVay procedure. Despite postoperative wound infection, she was discharged on postoperative day 25. Appendicitis in a hernia is rare. The concomitant inflammatory process is usually caused by extraluminal obstruction of the appendix. Signs and symptoms of acute appendicitis are often overshadowed by findings of an incarcerated hernia. CT is an accurate diagnostic modality in hernia appendicitis. Treatment is always surgical, although the precise procedure to be followed remains controversial.

Key words
femoral hernia, appendicitis, computed tomography

Reprint requests
Tomo Osako Department of Surgery, Ayabe Municipal Hospital
20-1 Otsuka, Aono-cho, Ayabe, 623-0011 JAPAN

Accepted
December 17, 2004

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