Introduction: Hernias containing the appendix are well-known entities that preferentially affect the groin. The presence of an appendix within a Spigelian hernia, which is a rare ventral hernia that presents with nonspecific symptoms and location, adds significantly to the complexity and rarity of its diagnosis. Further, only 18 such cases were reported and published in the literature. We report a case of Spigelian hernia and appendicitis within the hernial sac to highlight the diagnostic challenges associated with this type of hernia. Case Presentation: In her late 30s, a female who underwent laparoscopic surgery for a uterine fibroid two and a half years back presented with right lower quadrant abdominal pain for two days. This followed abdominal pain on exertion for the previous nine months. On examination, there was tenderness, guarding, and a positive cough impulse in the right lower quadrant of the abdomen. Her body mass index was 37.53 kg/m2. A contrast-enhanced computed tomography imaging of the abdomen reported a right iliac fossa incisional hernia with omental congestion necessitating an emergency laparoscopic surgery. At surgery, a Spigelian hernia, which was at least 5 cm away from the port site scar of the previous surgery, was found. The hernia contained an inflamed appendix. Thus, a diagnosis of Spigelian hernia and appendicitis within the hernial sac was made. A laparoscopic reduction and repair of the Spigelian hernia and a laparoscopic appendectomy were performed. Conclusion: Whereas Spigelian hernias are considerably rare, the presence of an appendix within a Spigelian hernia sac is yet a more infrequent occurrence. Although the imaging modalities are often inconclusive, careful interpretation of the computed tomography imaging findings may reveal the pathology preoperatively.

BackgroundLeptin is a neuroendocrine protein hormone with 167 amino acids mainly produced by adipose tissue that regulates food intake and energy expenditure to maintain relative stability of body weight and energy storage over long period of time. A single nucleotide polymorphism in leptin, consisting of G to A substitution at nucleotide −2548 upstream from ATG start site (LEP G‐2548A, rs7799039) has been found to influence leptin expression, possibly at the transcriptional level and was associated with increased leptin secretion in adipocytes. However, these high levels of leptin do not serve their function in controlling the obesity of these individuals possibly due to a condition known as ‘leptin resistance’.AimAssess the risk of the genetic polymorphism of leptin gene G‐2548A on obesity.Material and MethodA case‐control study which consisted of 66 individuals of different BMI (46 normal, 16 overweight and 4 obese). The different genotypes of leptin G‐2548A were determined by restriction fragment length polymorphism polymerase reaction after DNA extraction from saliva samples.ResultsA high risk of obesity was seen among carrier of AA genotype compared to other genotypes (GG&GA) (OR=2.6, 95% CI= 0.9–7.5). Furthermore AA genotype was found to be a risk factor for abdominal obesity (OR=1.3, 95%CI= 0.5–3.7).ConclusionCarrier of AA genotype of leptin G‐2548A polymorphism are at risk of obesity.Support or Funding InformationRak Medical and Health Sciences UniversityThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.