Incisional hernia appendicitis: A unique case report

INTRODUCTION AND IMPORTANCE: Incisional hernia appendicitis is very rare. Very few papers have been published reporting about Pfannenstiel incision hernia with appendicitis. Here we report one such case of Pfannenstiel hernia with appendicitis. CASE PRESENTATION: A 20 years old lady presented with a tender mass in the right iliac fossa after Pfannenstiel incision. Ultra-sonography showed an incisional hernia with a 12.1 mm defect at the site of the incision. A provisional diagnosis of strangulated hernia was made. Acute appendicitis was diagnosed intra-operatively. Appendectomy followed by primary repair of the hernia was done. The patient had an uneventful recovery postoperatively and was discharged on the third day without any complications. Histopathology confirmed appendicitis. CLINICAL DISCUSSION: Amyand originally documented the presence of appendix within external hernias. The presence of appendicitis within an incisional hernia is even rarer. Hypermobility of the cecum, inflammatory adhesions from surgery and defects created during surgery have been considered as the pathological basis of such incisional hernias. A classic presentation of appendicitis may be absent in cases of incisional hernia appendicitis. Deviation from usual clinical symptoms often deviates from treating surgeons to assume it as strangulated/incarcerated hernia. Incisional hernia appendicitis management consists of appendectomy followed by subsequent primary hernia repair. The use of mesh for repair is not preferred. CONCLUSION: Incisional hernia appendicitis diagnosis is almost always intraoperative. As the incidence of incisional hernia appendicitis is low, awareness about the possibility of its occurrence is essential to formulate a well-planned intra-operative strategy.