ACUTE APPENDICITIS INCARCERATED IN AN EPIGASTRIC HERNIA: A CASE REPORT

• DOI: https://doi.org/10.22533/at.ed.1594882426092

• Palavras-chave: Herniorrhaphy, Anatomical Variation, Appendicitis

• Keywords: Herniorrhaphy, Anatomical Variation, Appendicitis

• Abstract:

  Introduction: Acute appendicitis is the main cause of surgical acute abdomen in hospital emergency departments, while hernias are common, mainly in elective surgical procedures, but also recurrent in emergencies. The presence of hernias containing vermiform appendages is rare, with a minimal incidence in acute appendicitis. This study reports a case of an incarcerated epigastric hernia containing a vermiform appendix that evolved into acute appendicitis, requiring emergency surgery. Methodology: The study is an exploratory case report, with detailed follow-up of the patient, including photographic records and data from the electronic medical record. Signed permission was obtained from the patient by means of an informed consent form and an image use agreement. Case report: A 44-year-old obese man presented to the emergency department with severe supraumbilical abdominal pain and a history of infraumbilical hernioplasty. Examinations revealed an incarcerated epigastric hernia containing acute appendicitis, confirmed during surgery. After appendectomy and hernia repair with mesh, the patient made a satisfactory recovery. Discussion: Abdominal hernias are classified by location and content. Among the most common are umbilical, inguinal, femoral, incisional and epigastric hernias. Some, such as Garengeot's and Amyand's, notable for involving the caecal appendix, are rarer. The epigastric hernia, located between the sternum and the umbilicus, is uncommon and even rarer when it contains the caecal appendix, and can evolve into acute appendicitis, requiring emergency surgery due to the risk of serious complications. This case highlights the importance of differential diagnosis in acute abdomen and contributes to clinical and surgical knowledge. Conclusion: Acute appendicitis in epigastric hernia is exceptionally rare and requires careful documentation in the medical literature. This case highlights the importance of considering uncommon diagnoses in the acute abdomen. Reporting and recording these cases is crucial to improving clinical and surgical approaches, enabling early recognition and treatment of these conditions in future clinical presentations.