外鼠径ヘルニア内の穿孔性虫垂炎の１例

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  • A CASE OF PERFORATIVE APPENDICITIS IN LATERAL INGUINAL HERNIA

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A 73-year-old woman complaining of right lower abdominal pain had a tumor with redness and pain at the right inguinal region. Abdominal plain x-ray film showed calcification suggestive of fecalith at the right inguinal region. Pelvic CT scans revealed lumen structure with high density image at the same region and Niveau formation in the vicinity of the structure. Then lateral inguinal hernia in which the appendix was impacted was diagnosed. Surgery was started with laparotomy to prevent probable intraabdominal progress of inflammation because of severe inflammatory reaction; and appendectomy was performed within the hernia sac, and removal of hernia sac with high ligation was performed after confirmation of absence of intraabdominal inflammation.<br>It is very rare that the appendix is incarcerated in a lateral inguinal hernia, and the condition is called Amyand's hernia. As far as we could review, only 11 cases of such rare hernia, including ours, have been reported in Japan. Preoperative diagnosis of the disease is difficult, but CT that can clearly visualize the inside of hernia sac is thought to be of value. And in cases in which severe inflammatory reaction is shown like in this case, bilateral approaches from the inguinal region and abdomen would be demanded.

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