Where have I lost my appendix? An unusual finding of acute appendicitis within an irreducible umbilical hernia sac. Case report.: Acute appendicitis in an umbilical hernia.

Where have I lost my appendix? An unusual finding of acute appendicitis within an irreducible umbilical hernia sac. Case report.

Acute appendicitis in an umbilical hernia.

Authors

Keywords:

Umbilical hernia, Appendicitis, Laparoscopy, Mesh repair, IPOM.

Abstract

An umbilical hernia is the bulging of the omentum, preperitoneal fatty tissue, or bowel out of the abdominal cavity through the umbilical orifice. The incidence of umbilical hernia follows that of the inguinal and the crural hernia. It is frequent in women, obese patients, smokers, and patients with ascites. It is an often asymptomatic pathological entity, which, however, can become complicated by giving rise to bowel obstruction, irreducibility, and ischemia. The finding of the appendix within an inguinal or a femoral hernia is called Amyand's hernia and De Garengeot's hernia, respectively. The presence of the appendix inside an umbilical hernia is instead a rare event. To date, 11 cases of complicated umbilical hernia containing the appendix have been described in the literature.

We present the case of a patient admitted to our surgical department for an acutely irreducible umbilical hernia. Due to the failure to reduce the hernia with taxis and the persistence of hernia incarceration, the patient underwent laparoscopic surgery. Intraoperatively, catarrhal appendicitis was found within the hernia sac. After the appendectomy and the reduction of the hernia content, a laparoscopic mesh repair (IPOM) was performed. The post-operative course was uneventful, and the discharge happened on the second post-operative day.

This case report demonstrates the importance of promptly intervening in complicated umbilical hernias. The laparoscopic technique has shown to be safe because, in the absence of intra-abdominal enteric leakage, mesh repair by laparoscopy offered the advantage of an early post-operative recovery and time to return to daily activities

References

Bedewi MA, El-Sharkawy MS, Al Boukai AA, Al-Nakshabandi N. Prevalence of adult paraumbilical hernia. Assessment by high-resolution sonography: a hospital-based study. Hernia. 2012 Feb;16(1):59-62. doi: 10.1007/s10029-011-0863-4.

Kaufmann R, Halm JA, Eker HH, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet. 2018 Mar 3;391(10123):860-869. doi: 10.1016/S0140-6736(18)30298-8.

Liang MK, Holihan JL, Itani K, et al. Ventral Hernia Management: Expert Consensus Guided by Systematic Review. Ann Surg. 2017 Jan;265(1):80-89. doi: 10.1097/SLA.0000000000001701.

Doig CM. Appendicitis in umbilical hernial sac. Br Med J. 1970 Apr 11;2(5701):113-4. doi: 10.1136/bmj.2.5701.113-b.

Arnáiz J, Ortiz A, Marco de Lucas E, et al. Unusual perforated appendicitis within umbilical hernia: CT findings. Abdom Imaging. 2006 Nov-Dec;31(6):691-3. doi: 10.1007/s00261-005-8009-8.

Agarwal N, Goyal S, Kumar A, Garg A, Kaur N, Gupta A. Appendicitis in paraumbilical hernia mimicking strangulation: a case report and review of the literature. Hernia. 2013 Aug;17(4):531-2. doi: 10.1007/s10029-013-1118-3. Epub 2013 May 26. PMID: 23708684.

Lam A, Black J, Parnell B, West CT. Appendicitis due to incarceration within a laparoscopic umbilical port-site hernia secondary to a degree of intestinal malrotation. Ann R Coll Surg Engl. 2019 May;101(5):e119-e121. doi: 10.1308/rcsann.2019.0034. Epub 2019 Mar 11. PMID: 30854864; PMCID: PMC6513357.

Sigley K, Russo T, Welch S. Umbilical Hernia Containing Appendicitis. Cureus. 2020 May 12;12(5):e8075. doi: 10.7759/cureus.8075. PMID: 32542130; PMCID: PMC7290121.

Atabek C, Sürer I, Deliağa H, et al. Appendicitis within an umbilical hernia sac: previously unreported complication in children. Ulus Travma Acil Cerrahi Derg. 2008 Jul;14(3):245-6. PMID: 18781423.

Zormpa A, Alfa-Wali M, Chung A. Appendicitis within the contents of an incarcerated paraumbilical hernia. BMJ Case Rep. 2019 Aug 10;12(8):e228915. doi: 10.1136/bcr-2018-228915.

Huntington JT, Mansfield SA, Drosdeck JM, Zhang G, Evans DC. A case of a strangulated umbilical hernia causing gangrenous appendicitis. Int J Colorectal Dis. 2016 May;31(5):1075-1076. doi: 10.1007/s00384-015-2412-6.

Hudson D, Thirunavukkarasu P. Case of perforated appendicitis within an umbilical hernia. ANZ J Surg. 2020 Jul;90(7-8):1496-1497. doi: 10.1111/ans.15561.

Pilgrim A, Russo R, Moulin A. A gut feeling: an extremely rare case of missed appendicitis. Western Journal of Emergency Medicine. 2014 Nov;15(7):852.

Galiñanes EL, Ramaswamy A. Appendicitis found in an incisional hernia. J Surg Case Rep. 2012 Aug 1;2012(8):3. doi: 10.1093/jscr/2012.8.3. PMID: 24960761; PMCID: PMC3649585.

Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol. 2002 Dec;179(6):1429-35. doi: 10.2214/ajr.179.6.1791429.

Kler A, Hossain N, Singh S, Scarpinata R. Vermiform appendix within incisional hernia. BMJ Case Rep. 2017 Aug 20;2017:bcr2017221216. doi: 10.1136/bcr-2017-221216.

Sugrue C, Hogan A, Robertson I, Mahmood A, Khan WH, Barry K. Incisional hernia appendicitis: A report of two unique cases and literature review. Int J Surg Case Rep. 2013;4(3):256-8. doi: 10.1016/j.ijscr.2012.12.006.

Hassan TA, Shalaby H, Eskander A. Incarcerated appendicitis in port-site hernia: a rare case report. Egyptian J Radiol Nuclear Med. 2015;3:569–571.

Jones MW, Lopez RA, Deppen JG: Appendicitis. StatPearls [Internet]. StatPearls Publishing, Treasure Island, FL; 2020.

Park JS, Jeong JH, Lee JI, Lee JH, Park JK, Moon HJ. Accuracies of diagnostic methods for acute appendicitis. Am Surg. 2013 Jan;79(1):101-6.

Frey S, Jurczak F, Fromont G, et al. Are the relative benefits of open versus laparoscopic intraperitoneal mesh repair of umbilical hernias dependent on the diameter of the defect? Surgery. 2022 Feb;171(2):419-427. doi: 10.1016/j.surg.2021.08.003.

Mayo WJ. VI. An Operation for the Radical Cure of Umbilical Hernia. Ann Surg. 1901 Aug;34(2):276-80. doi: 10.1097/00000658-190107000-00021.

Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon MJ. Divino CM. Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Ann Surg. 2012 Jan;255(1):176-80. doi: 10.1097/SLA.0b013e31822518e6.

Cassie S, Okrainec A, Saleh F, Quereshy FS, Jackson TD. Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program. Surg Endosc. 2014 Mar;28(3):741-6. doi: 10.1007/s00464-013-3252-5.

Christoffersen MW, Westen M, Rosenberg J, Helgstrand F, Bisgaard T. Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial. Br J Surg. 2020 Feb;107(3):200-208. doi: 10.1002/bjs.11490.

Campanile FC, Podda M, Pecchini F, et al. Italian Laparoscopic Ventral Hernia Guideline Group. Laparoscopic treatment of ventral hernias: the Italian national guidelines. Updates Surg. 2023 Aug;75(5):1305-1336. doi: 10.1007/s13304-023-01534-3.

Birindelli A, Sartelli M, Di Saverio S, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2017 Aug 7;12:37. doi: 10.1186/s13017-017-0149-y. PMID: 28804507; PMCID: PMC5545868.

Henriksen NA, Montgomery A, Kaufmann R, et al. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg. 2020 Feb;107(3):171-190. doi: 10.1002/bjs.11489. Epub 2020 Jan 9. PMID: 31916607.

Bedewi MA, El-Sharkawy MS, Al Boukai AA, Al-Nakshabandi N. Prevalence of adult paraumbilical hernia. Assessment by high-resolution sonography: a hospital-based study. Hernia. 2012 Feb;16(1):59-62. doi: 10.1007/s10029-011-0863-4.

Kaufmann R, Halm JA, Eker HH, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet. 2018 Mar 3;391(10123):860-869. doi: 10.1016/S0140-6736(18)30298-8.

Liang MK, Holihan JL, Itani K, et al. Ventral Hernia Management: Expert Consensus Guided by Systematic Review. Ann Surg. 2017 Jan;265(1):80-89. doi: 10.1097/SLA.0000000000001701.

Doig CM. Appendicitis in umbilical hernial sac. Br Med J. 1970 Apr 11;2(5701):113-4. doi: 10.1136/bmj.2.5701.113-b.

Arnáiz J, Ortiz A, Marco de Lucas E, et al. Unusual perforated appendicitis within umbilical hernia: CT findings. Abdom Imaging. 2006 Nov-Dec;31(6):691-3. doi: 10.1007/s00261-005-8009-8.

Agarwal N, Goyal S, Kumar A, Garg A, Kaur N, Gupta A. Appendicitis in paraumbilical hernia mimicking strangulation: a case report and review of the literature. Hernia. 2013 Aug;17(4):531-2. doi: 10.1007/s10029-013-1118-3. Epub 2013 May 26. PMID: 23708684.

Lam A, Black J, Parnell B, West CT. Appendicitis due to incarceration within a laparoscopic umbilical port-site hernia secondary to a degree of intestinal malrotation. Ann R Coll Surg Engl. 2019 May;101(5):e119-e121. doi: 10.1308/rcsann.2019.0034. Epub 2019 Mar 11. PMID: 30854864; PMCID: PMC6513357.

Sigley K, Russo T, Welch S. Umbilical Hernia Containing Appendicitis. Cureus. 2020 May 12;12(5):e8075. doi: 10.7759/cureus.8075. PMID: 32542130; PMCID: PMC7290121.

Atabek C, Sürer I, Deliağa H, et al. Appendicitis within an umbilical hernia sac: previously unreported complication in children. Ulus Travma Acil Cerrahi Derg. 2008 Jul;14(3):245-6. PMID: 18781423.

Zormpa A, Alfa-Wali M, Chung A. Appendicitis within the contents of an incarcerated paraumbilical hernia. BMJ Case Rep. 2019 Aug 10;12(8):e228915. doi: 10.1136/bcr-2018-228915.

Huntington JT, Mansfield SA, Drosdeck JM, Zhang G, Evans DC. A case of a strangulated umbilical hernia causing gangrenous appendicitis. Int J Colorectal Dis. 2016 May;31(5):1075-1076. doi: 10.1007/s00384-015-2412-6.

Hudson D, Thirunavukkarasu P. Case of perforated appendicitis within an umbilical hernia. ANZ J Surg. 2020 Jul;90(7-8):1496-1497. doi: 10.1111/ans.15561.

Pilgrim A, Russo R, Moulin A. A gut feeling: an extremely rare case of missed appendicitis. Western Journal of Emergency Medicine. 2014 Nov;15(7):852.

Galiñanes EL, Ramaswamy A. Appendicitis found in an incisional hernia. J Surg Case Rep. 2012 Aug 1;2012(8):3. doi: 10.1093/jscr/2012.8.3. PMID: 24960761; PMCID: PMC3649585.

Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol. 2002 Dec;179(6):1429-35. doi: 10.2214/ajr.179.6.1791429.

Kler A, Hossain N, Singh S, Scarpinata R. Vermiform appendix within incisional hernia. BMJ Case Rep. 2017 Aug 20;2017:bcr2017221216. doi: 10.1136/bcr-2017-221216.

Sugrue C, Hogan A, Robertson I, Mahmood A, Khan WH, Barry K. Incisional hernia appendicitis: A report of two unique cases and literature review. Int J Surg Case Rep. 2013;4(3):256-8. doi: 10.1016/j.ijscr.2012.12.006.

Hassan TA, Shalaby H, Eskander A. Incarcerated appendicitis in port-site hernia: a rare case report. Egyptian J Radiol Nuclear Med. 2015;3:569–571.

Jones MW, Lopez RA, Deppen JG: Appendicitis. StatPearls [Internet]. StatPearls Publishing, Treasure Island, FL; 2020.

Park JS, Jeong JH, Lee JI, Lee JH, Park JK, Moon HJ. Accuracies of diagnostic methods for acute appendicitis. Am Surg. 2013 Jan;79(1):101-6.

Frey S, Jurczak F, Fromont G, et al. Are the relative benefits of open versus laparoscopic intraperitoneal mesh repair of umbilical hernias dependent on the diameter of the defect? Surgery. 2022 Feb;171(2):419-427. doi: 10.1016/j.surg.2021.08.003.

Mayo WJ. VI. An Operation for the Radical Cure of Umbilical Hernia. Ann Surg. 1901 Aug;34(2):276-80. doi: 10.1097/00000658-190107000-00021.

Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon MJ. Divino CM. Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Ann Surg. 2012 Jan;255(1):176-80. doi: 10.1097/SLA.0b013e31822518e6.

Cassie S, Okrainec A, Saleh F, Quereshy FS, Jackson TD. Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program. Surg Endosc. 2014 Mar;28(3):741-6. doi: 10.1007/s00464-013-3252-5.

Christoffersen MW, Westen M, Rosenberg J, Helgstrand F, Bisgaard T. Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial. Br J Surg. 2020 Feb;107(3):200-208. doi: 10.1002/bjs.11490.

Campanile FC, Podda M, Pecchini F, et al. Italian Laparoscopic Ventral Hernia Guideline Group. Laparoscopic treatment of ventral hernias: the Italian national guidelines. Updates Surg. 2023 Aug;75(5):1305-1336. doi: 10.1007/s13304-023-01534-3.

Birindelli A, Sartelli M, Di Saverio S, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2017 Aug 7;12:37. doi: 10.1186/s13017-017-0149-y. PMID: 28804507; PMCID: PMC5545868.

Henriksen NA, Montgomery A, Kaufmann R, et al. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg. 2020 Feb;107(3):171-190. doi: 10.1002/bjs.11489. Epub 2020 Jan 9. PMID: 31916607.

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Published

21-06-2024

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CASE REPORTS

How to Cite

1.
Pilia T, Murzi V, Locci E, Gessa E, Corronca F, Frongia F, et al. Where have I lost my appendix? An unusual finding of acute appendicitis within an irreducible umbilical hernia sac. Case report.: Acute appendicitis in an umbilical hernia. Acta Biomed [Internet]. 2024 Jun. 21 [cited 2024 Jul. 20];95(3):e2024049. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/14598