Perforated Appendicitis within the Sac of a Recurrent Incisional Hernia: A Rare Occurrence

Abstract

Perforated hernial appendicitis rarely occurs with an incidence of 0.008%. We present a case of a young obese woman, a known hypertensive, who presented with abdominal pain, fever, and a tender abdominal swelling over a previous lower midline incision scar. She was thought to have a strangulated recurrent incisional hernia and was offered an emergency laparotomy. Intraoperatively, she was found to have a massive multiloculated hernia sac with the caecum, ruptured appendicitis, and abscess within a locus of the sac. Her ascending colon was mobile. The abscess was drained, appendicectomy was done, hernia repair deferred, and wound closure effected. Such atypical presentation poses a diagnostic challenge. We seek to increase awareness of this condition and contribute to the medical literature surrounding this unusual pathology.

Keywords: Appendicitis, incisional hernia, perforation