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Appendicular abscess with appendicolith in a Spigelian hernia masquerading caecal volvulus-A case report
G A Demetriou1, M S Nair, Y Al-Abed
1Department of Emergency Medicine, North Middlesex University Hospital, London N18 1QX, UK.
International Journal of Surgery Case Reports
|July 10, 2012
Summary
Spigelian hernias are rare abdominal wall hernias. A case report details a Spigelian hernia containing an appendiceal abscess and appendicolith, highlighting diagnostic challenges.
Area of Science:
- Abdominal Surgery
- Hernia Repair
- Diagnostic Imaging
Background:
- Spigelian hernias are rare, accounting for approximately 2% of all hernias.
- They are located in the anterior abdominal wall, named after anatomist Adrian van den Spiegel.
Purpose of the Study:
- To present a unique case of Spigelian hernia.
- To highlight the diagnostic challenges associated with Spigelian hernias.
Main Methods:
- Case report of an 83-year-old female with a painful right iliac fossa swelling.
- Clinical examination and computed tomography (CT) scan were performed.
- Intra-operative findings revealed the contents of the hernia.
Main Results:
- Computed tomography (CT) scan suggested a caecal volvulus.
- Intra-operatively, a Spigelian hernia was found containing an appendiceal abscess and an appendicolith.
- This specific combination of contents is novel in the literature.
Conclusions:
- Spigelian hernias pose diagnostic challenges due to their rarity and varied contents.
- Clinicians must maintain a high index of suspicion for Spigelian hernias in cases of lower abdominal swelling.
- Awareness is crucial, even with negative clinical and CT findings.
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