Appendicitis in an obturator hernia

Abstract

We present a case of a 79-year-old female with a history of pain at the right groin for 9 days. Computer tomography of the pelvis showed herniation of the appendix through the obturator canal with a huge abscess surrounding the right hip joint. Laparotomy was performed and histopathology confirmed a perforated necrotic tip of the herniated appendix. An obturator hernia is a rare hernia of the pelvic floor. It is most common in old, emaciated, multiparous women and can cause groin pain with extension to the medial aspect of the thigh. In case of incarceration of bowel, patients also present with obstruction. Isolated incarceration of the appendix, however, does not cause obstruction. The diagnosis of an obturator hernia is often delayed, due to a non-specific clinical presentation. CT scan may offer the clue to the correct diagnosis and should be performed in case of a possible obturator hernia.

Acute appendicitis within an obturator hernia

“…In three of these cases,1 2 4 isolated herniation of the appendix was present. In the fourth case,3 a knuckle of terminal ileum was also found in the hernia sac.…”

“…In three of the cases,1 3 4 the patients were managed surgically with a laparotomy, while in the other case, by Kjossev et al ,2 the patient had an initial laparoscopic approach, which was then converted to a laparotomy. In that case, Kjossev et al also used multiple incisions to open the thigh as turbid, foul smelling, dishwater-like fluid had tracked into that region.…”

Subtotal Appendectomy to Treat Gangrenous Appendicitis Incarcerated in an Obturator Hernia

“…Only 1 of the 5 prior cases had a diagnosis of obturator hernia seen on CT imaging prior to the operating room, lending to this interesting problem. 3 In conclusion, obturator hernias containing the appendix are exceedingly rare. CT imaging is appropriate as a diagnosing modality.…”

“…1 Even more rare are obturator hernias containing the appendix with only 5 prior cases found on our literature search. [2][3][4][5][6] Although herniation of the appendix has been described in inguinal and femoral hernias, called Amyand and De Garengeot hernias, respectively, there is no eponym for a herniated appendix in an obturator hernia. If incarceration of bowel loops occurs, obstruction and subsequent symptoms follow acutely leading to prompt presentation and treatment.…”

“…As seen with only 2 of the 5 prior cases, our patient presented with appendicitis while the other 3 cases presented with right thigh or groin pain and resulted in death postoperatively from septic shock. [2][3][4][5][6] The appendix was resected to the extent that was possible with safe dissection. With the amount of inflammation, fecalith, and perforated appendix, the decision to leave a drain successfully treated the patient without postoperative abscess formation.…”