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CASE REPORT
Rare and unusual case of perforated appendicitis in a Spigelian hernia
  1. Michael John Cox1,
  2. Alfred Adiamah1,
  3. Abeed Chowdhury1,
  4. Asim Shah2
  1. 1Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2Interventional Radiology, Queen’s Medical Centre, Nottingham, UK
  1. Correspondence to Mr Michael John Cox, michael.cox8{at}nhs.net

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Background

  1. Amyand hernia is a rare phenomenon, defined as an inguinal hernia containing the vermiform appendix. It is seen in less than 1% of inguinal hernias. Claudius Amyand first reported this interesting finding in 1735.

  2. De Garengeot hernia: this is the clinical finding of the vermiform appendix within a femoral hernia sac; it occurs in less than 1% of all femoral hernias and is named after the French surgeon, Rene Jacques Croissant de Garengeot.

  3. Unnamed: The clinical entity we describe in this case report is the last of the ‘appendix in a hernia—yet to be eponymously named’. It is an interesting and intriguing clinical finding, yet without a referenced name it does not immediately come to mind as a potential differential diagnosis. Medical historians may well commence the search for the first description of the condition.

Case presentation

An 83-year-old woman was admitted to the surgical triage unit of a teaching hospital with a 10-day history of worsening right-sided abdominal pain. This was associated with a 4-day history of diarrhoea and fullness in her right lower quadrant of the abdomen. She reported nausea but no vomiting and associated fevers for the preceding 2 days in community. Systemic enquiry revealed no further symptoms. Medical history included hypertension and a caesarean section.

On physical examination, the …

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