Acute appendicitis in Spiegel's hernia: a case report
DOI:
https://doi.org/10.69849/ef6rgd11Keywords:
Spiegel Hernia, Appendicitis, Surgery, Exploratory, laparotomyAbstract
INTRODUCTION: Spiegelian hernias stand out for being rare, constituting about 2% of abdominal wall hernias, with higher prevalence in women. Spiegel's hernia corresponds to an irregularity of the abdominal wall that causes protrusion of organs, peritoneal sac or pre-peritoneal fat through Spiegel's aponeurosis.
CASE REPORT: A 52-year-old male patient presented to the emergency service reporting intense pain in the right iliac fossa that had been evolving for 3 months, associated with difficulty walking and fever. On physical examination, the abdomen was globose with the presence of a palpable mass in the right iliac fossa with defined margins and approximately 15 cm in diameter with no signs of peritoneal irritation. Complementary exams showed leukocytosis (16,840/mm³), ultrasound showed heterogeneous collection comprising the inferolateral portion of the right transverse, internal and external oblique muscles and CT of abdomen and pelvis with a report that detected intramuscular collection without cleavage planes with the intestine. After the exam results, the patient was submitted to exploratory laparotomy, in which an inflammatory process and blockage of the cecum by epiplon and mesocolon of the terminal ileal loop were identified, besides firm adherence between the lateral face of the right abdominal wall, 5 cm above the anterosuperior iliac crest with the mentioned process.
DISCUSSION: The manifestation of Spiegel's Hernia may originate from an aponeurotic defect that can be congenital from birth or acquired throughout life, in the case cited, it is suspected that the hernia originated from an automobile accident that the patient suffered. The clinical diagnosis of this hernia is difficult because this condition causes an indistinct pain in a small hernial protrusion that extends between the muscles of the abdominal wall. Because of this, imaging tests such as ultrasound and CT scan are often useful to confirm the diagnosis. Surgical treatment is mandatory due to the high risk of complications, in the reported case the treatment occurred in a complication of Spiegel's Hernia.
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