Amyand appendicitis

Published:March 31, 2022DOI:
      An 85-year-old man presented to the emergency department with a 2-day history of right lower quadrant abdominal pain radiating to his groin. He had a history of hypercholesterolemia managed with cholesterol-lowering therapy. On examination, he had a low-grade temperature of 37.9°C, was normotensive at 130/70 mm Hg, tachycardic at 110 beats per minute, tachypnoeic with a respiratory rate of 20, and was saturating at 95% on room air. On palpation, he had a tender lump in his right inguinal region, without evidence of peritonism. His blood tests revealed an elevated white cell count of 12 × 109/L and an elevated C-reactive protein of 30 mg/L. Computed tomography (CT) of the abdomen and pelvis was performed. On review of the imaging (Figure 1), what diagnosis explains this patient’s clinical presentation?
      • A)
        Berger’s hernia
      • B)
        Maydl hernia
      • C)
        Amyand hernia with appendicitis
      • D)
        Littre hernia with Meckel’s diverticulitis
      Figure thumbnail gr1
      Figure 1Coronal CT of the abdomen demonstrates a right sided inguinal hernia containing the appendix. There is also abnormal dilatation of the appendix, wall thickening, periappendiceal fat stranding, and free fluid in keeping with acute appendicitis.
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