Fascitis necrotizante de la pared abdominal como presentación infrecuente de una hernia de Garengeot: Caso clínico

Abstract

Garengeot's hernia corresponds to the presence of the appendix within a femoral hernia, associated or not with acute appendicitis. The diagnosis of this uncommon situation is usually done during surgery. Furthermore, the clinical presentation as necrotizing fasciitis is a rare condition. We report a 54 years old obese hypertensive woman with rheumatoid arthritis of 40 years of evolution treated with methotrexate and prednisone. She consulted for pain and erythema in the right inguinal region. Laboratory revealed leukocytosis and an elevated C-reactive Protein. Suspecting a cellulitis, the patient was admitted for antimicrobial therapy. A pelvic magnetic resonance imaging showed a perforated acute appendicitis in an inguinal hernia with extensive pelvic cellulitis associated with signs of fasciitis. At surgery, an extensive groin and pubic fasciitis was evident, with a necrotic and perforated appendix within a femoral hernia. Surgical debridement, open appendectomy, and femoral hernioplasty without mesh were carried out. Vacuum-assisted closure was installed in the coverage defect. Three surgical debridement procedures were required for the closure of the wound. Two weeks after the first surgical procedure, the patient was discharged in good condition. During the follow-up, she evolved with a surgical wound dehiscence, which was managed with wound dressings until closure.

Hernia de Garengeot y revisión de las variantes de hernias encarceladas

“…Mediante esta técnica de mínima invasión se realiza la apendicectomía y la corrección de la hernia con técnica TAPP o TEP [27][28][29] . También se ha descrito la reparación del defecto herniario en un segundo tiempo quirúrgico 27 .…”

“…Mediante esta técnica de mínima invasión se realiza la apendicectomía y la corrección de la hernia con técnica TAPP o TEP [27][28][29] . También se ha descrito la reparación del defecto herniario en un segundo tiempo quirúrgico 27 . Ramsingh et al describieron el primer abordaje combinado en hernia de Garengeot con herniorrafia por vía inguinal y apendicectomía vía laparoscópica 30 .…”

“…Ramsingh et al describieron el primer abordaje combinado en hernia de Garengeot con herniorrafia por vía inguinal y apendicectomía vía laparoscópica 30 . En pacientes con sospecha de proceso infeccioso que requieren lavado quirúrgico local se recomiendan abordajes combinados 27,28,30 .…”