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Introduction: Hiatal hernia and abdominal wall hernia (AWH) have a common theme of pathogenesis and etiology. This suggests a potential relationship between these 2 types of hernia. However, no large studies have examined such an association. We designed the current study to characterize this association and identify factors associated with this coexistence. Methods: A database of patients seen at a large multi-center health network serving 3 states in the mid-Atlantic region of the United States was queried for patients with a documented diagnosis of hiatal hernia (HH) or paraesophageal hernia (PEH). This population was then divided into groups based on whether or not they had a history of another type of AWH (ventral, inguinal/ femoral, umbilical, or incisional hernia). Demographic and clinical data were compared between groups using univariate, followed by multivariable logistic analysis. Results: The final study population consisted of 28 114 patients (66.5% female) with HH/PEH. The prevalence of AWH in this population was 8.2% (n = 2299). Of these 69.1% had only one AWH with the remaining 30.9% having two or more hernias. Multivariable analysis showed male patients with HH/PEH were more likely to have AWH (OR: 1.97; 95% CI: 1.810-2.162, P <0 .0001). The odds of AWH were higher in patients aged 50 to 80 years old compared to younger patients (OR: 1.527; 95% CI: 1.348-1.730, P <0 .0001). Patients with any comorbidity were also more likely to develop AWH (OR: 1.764; 95% CI: 1.566-1.986, P < 0.0001), with obstructive sleep apnea (OSA) being the comorbidity with the highest risk (OR: 1.295; 95% CI: 1.161-1.444, P <0 .0001), followed by obesity (OR: 1.267; 95% CI: 1.156-1.388, P <0 .0001). Conclusion: The prevalence of an AWH in patients with a HH/PEH was 8.2%. Although HH/PEH are more prevalent in females, males with HH/PEH are at higher risk for AWH. Obesity, OSA, tobacco use, hypertension, diabetes, and hypothyroidism are independent risk factors for presence of an AWH in patients with HH/PEH.

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Introduction Appendiceal adenocarcinomas, although rare, usually present as slow-growing masses. Rarely, do they rapidly enlarge into large abdominal masses over a short period of time. Generally, we attribute rapidly growing abdominal masses to sarcomas, desmoid tumors, or gynecological masses. We present a case of a rapidly growing appendiceal adenocarcinoma in an elderly patient. Case presentation We report a case of an 83-year-old-male who presented with a one-month history of abdominal pain. A computer tomography (CT) scan identified a lower pelvic mass measuring 7.39 cm × 5.40 cm. A biopsy was done which revealed appendiceal carcinoma. A plan for radiotherapy to reduce the tumor size was made and the patient was discharged. However, the patient returned after three weeks due to worsening abdominal pain and a CT scan identified a significant enhancement in the tumor size. The patient underwent debulking surgery. Pathology of the specimen identified adenocarcinoma of the appendix. Discussion A rapidly growing carcinoma of the appendix is rare as they are known to have a slow growth rate. A swift diagnosis and intervention are required as these rapidly enhancing neoplasms in the abdomen can become unresectable and metastasize. Although there are various methods of treatment for appendiceal carcinomas, the rapid growth rate and lack of response to radiation required debulking surgery. Conclusion There exist a myriad of differential diagnoses for a rapidly growing mass in the abdomen. We are presenting the first documented case of a rapidly growing appendiceal adenocarcinoma. Surgeons should be aware of the variety of differentials in such cases.