APPENDICITIS WITHIN RECURRENT HERNIA ON GERIATRIC PATIENT: AN UNUSUAL AMYAND'S HERNIA

Öz

In a 73 year old male patient who admitted to emergency service with general medical condition disorder, high fever, unconsciousness, had no abdominal complaints prior to admission and had a right inguinal hernia surgery twice, one due to recurrence in the medical history, recurrent right Amyand hernia and appendicitis were detected. A laparoscopic appendectomy was performed in this atypical clinic. Although  appendicitis  due to Amyand hernia  is observed in less than 0.1% of patients, by sharing this patient’s findings and treatment protocol whose second recurrence of hernia  has developed as  Amyand, it was aimed to remind that especially appendicitis in the hernia sac may lead to a systemic infection clinic without localized peritonitis findings and even in patients who have undergone multiple hernia operations, recurrent / indirect inguinal hernia may be present.

Anahtar Kelimeler

• Amyand's hernia,groin hernia,appendicitis,peritonitis

Geriyatrik hastada tekrarlayan kasık fıtığında akut apandisit: Ender bir amyand herni olgusu

Öz

Acil servise genel durum bozukluğu, ateş yüksekliği ve bilinç bulanıklığı ile başvuran, başvuru öncesi herhangi bir abdominal şikâyeti olmayan ve tıbbi özgeçmişinde biri nüks nedeniyle olmak üzere iki defa sağ kasık fıtığı ameliyatı olan 73 yaşındaki erkek hastada, nüks sağ Amyand herni ve apandisit saptanmıştır. Atipik kliniği olan bu hastaya laparoskopik appendektomi yapılmıştır. Amyand hernide apandisit gelişme olasılığı %0.1’den az iken, ikinci nüks hernisi Amyand olarak gelişen bu hastanın bulguları ve uygulanan tedavi paylaşılarak, özellikle fıtık kesesi içerisindeki apandisitin, lokalize peritonit bulguları olmadan sistemik enfeksiyon kliniğine yol açabileceği, birden çok defa herni operasyonu geçiren hastalarda dahi nüks/atlanmış indirek inguinal herni olabileceği hatırlatılmak istenmiştir.

Anahtar Kelimeler

• Amyand herni,kasık fıtığı,apandisit,peritonit

Kaynakça

1. Singal R, Gupta S. “Amyand’s Hernia” – Pathophysiology, Role of Investigations and Treatment. Maedica (Burcahr). 2011;6(4):321–7.
2. Inan I, Myers PO, Hagen ME, Gonzalez M, Morel P. Amyand’s hernia: 10 years’ experience. Surgeon 2009;7(4):198–202.
3. Morales-Cárdenas A, Ploneda-Valencia CF, Sainz-Escárrega VH, Hernández-Campos AC, Navarro-Muñiz E, López-Lizarraga CR, et al. Amyand hernia: Case report and review of the literature. Ann Med Surg. 2015;4(2):113–5.
4. Kaymakci A, Akillioglu I, Akkoyun I, Guven S, Ozdemir A, Gulen S. Amyand’s hernia: a series of 30 cases in children. Hernia. 2009;13(6):609–12.
5. Hutchinson R. Amyand’s hernia. J R Soc Med. 1993;86: 104–5.
6. Suppiah A, Dharmlingum A, Swift S, Smith A. Acute appendicitis within a recurrent inguinal hernia presenting as epididymo-orchitis. J Surg Case Rep. 2012;2012:12.
7. Barut I, Tarhan Ö̈ R. A rare variation of Amyand’s hernia: Gangreneous appendicitis in an incarcerated inguinal hernia sac. Eur J Gen Med. 2008;5:112–4.
8. Meinke AK. Review article: Appendicitis in groin hernias. J Gastrointest Surg. 2007;11:1368–72.

9. Bay-Nielsen M, Nordin P, Nilsson E, Kehlet H. Operative findings in recurrent hernia after a Lichtenstein procedure. Am J Surg. 2001;182:134–6.
10. Michalinos A, Moris D, Vernadakis S. Amyand’s hernia: A review. Am J Surg. 2014;207:989–95.
11. Elbanna KY, Alzahrani HA, Azzumeea F, Alzamel HA. Neuroendocrine tumor of the appendix inside an incarcerated Amyand’s hernia. Int J Surg Case Rep 2015;14:152–5.