令人意外且有挑戰的腹股溝疝氣：發炎的阿曼德疝氣
唐慈翊1,2、錢祖明2、陳怡璇1,2、阮雍順2、柯宏龍1,2、葉信志1,2
高雄市立大同醫院1泌尿科
高雄醫學大學附設醫院2泌尿科
An unexpected, challenging inguinal hernia: inflamed Amyand's hernia
Tsz-Yi Tang1,2, Tsu-Ming Chien2, Yi-Hsuan Chen1,2, Yung-Shun Juan2, Hung-Lung Ke1,2, Hsin-Chih Yeh1,2
1Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Case report
A 66-year-old man presented to the emergency room with an acutely painful bulge in the right groin. He denied fever, chills, nausea, vomiting, or diarrhea. He had a history of hypertension. His vital signs showed tachycardia (109 bpm), high blood pressure (216/112 mmHg), and low-grade fever (37.7 'C). Physical examination revealed a right inguinoscrotal mass that was tender and nonreducible. Laboratory studies showed leukocytosis, elevated CRP levels, and azotemia. The rest of the results were within the normal range. Computed tomography of the abdomen revealed a right-sided inguinal hernia with increased bowel wall thickness, fluid collection, and infiltration (Figure 1). Tentative diagnosis was an incarcerated inguinal hernia. After a urology consultation, we performed an urgent right inguinal herniorrhaphy. Unexpectedly, the bulging mass was an incarcerated appendix (Figure 2). Appendiceal mucosal necrosis was observed, and appendectomy was done at the same time. For the huge inguinal defect, we placed a Progrip mesh to reinforce the abdominal wall. Pathology showed perforated appendix with mucosal necrosis and dense transmural infiltration of suppurative cells. After surgery, the patient received 5 days of intravenous antibiotics and was discharged on postoperative day 5. The sutures were removed on the 9th postoperative day. There were no complications or recurrent inguinal hernia one year postoperatively.
Conclusion:
We report a case of impending perforated appendicitis in the inguinal hernia undergoing right inguinal herniorrhaphy using a Progrip mesh. No perioperative or long-term complications were observed. Mesh repair may be feasible for an inflamed inguinal hernia.