Meckel’s diverticulum complications in three first-degree relatives: time to rethink familial predisposition?

Inflamed Right Inguinal Appendix in a Sixty-four-year-old Man: A Case Report and Review of the Literature

“…Inguinal appendix has been reported in all age groups, from neonates to the elderly [6]. It is more common in children due to the high prevalence of the inguinal hernia in this age group, occasioned by the persistence of the processus vaginalis [4]. With an incidence of about 2% of all appendicectomies among infants and neonates [7] inguinal appendix is reportedly more common in males and on the right side [4,6] However, left-sided inguinal appendices due to intestinal malrotation, situs inversus, or mobile caecal syndrome have been documented [8].…”

“…In the uninflamed appendix, the patient may present with reducible groin swelling. In rare cases, as in this patient, the appendix may be inflamed within the hernia sac, presenting with features of incarcerated inguinal hernia [2,4] Physical examination may reveal a painful, irreducible swelling in the groin with accompanying differential warmth and erythema of the overlying skin [2,6]. In addition, this condition has also been reported to present with intestinal obstruction, epididymitis, scrotal abscess, and enterocutaneous fistula.…”

“…In addition, this condition has also been reported to present with intestinal obstruction, epididymitis, scrotal abscess, and enterocutaneous fistula. [2,4,5,9,10]. This variation in presentation makes the pre-operative diagnosis of Amyand's hernia difficult.…”

“…Ultrasound can be helpful in the pre-operative diagnosis of Amyand's hernia as it shows a noncompressible tubular structure in the hernia sac. In addition, thickening of the wall and hyperaemia of the tubular structure may be observed if the appendix is inflamed [4,11] The author believe that imaging examination for incarcerated inguinal hernias can improve on the number of complicated Amyand's hernias that are pre-operatively diagnosed.…”

“…Appendicitis presenting in an incarcerated inguinal hernia is an extremely rare occurrence. The incidence of acute appendicitis in external herniae is about 0.13% of all cases of acute appendicitis [3][4].…”