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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 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.
