Perforated acute appendicitis in umbilical hernia-case report

Introduction and importance: An umbilical hernia is a primary hernia characterized by a defect in the midline at the umbilical ring. The presence of the appendix within an umbilical hernia is rare, and when appendicitis occurs within the hernia sac, it represents a surgical emergency requiring prompt intervention. Case presentation: A 57-year-old patient was brought by ambulance to the emergency department. She was septic, presenting with abdominal pain over the past 5 days. Multislice CT revealed an umbilical hernia measuring 41 mm in diameter that contained adipose tissue, fluid, and air bubbles. The patient underwent an emergency appendectomy with resection of the hernial sac and was admitted to the intensive care unit. Despite all therapeutic measures, the patient died on the first postoperative day due to septic shock. Clinical discussion: Although appendicitis is a common surgical condition, the presence of a perforated appendix within an umbilical hernia is extremely rare. Once the appendix is incarcerated within the hernia sac, it is highly susceptible to constriction at the narrow hernia neck. This leads to compromised lymphatic and venous drainage, luminal obstruction, bacterial overgrowth, and rapid progression to ischemia. Delayed treatment of acute appendicitis may result in life-threatening complications, including septic shock. Conclusion: Appendicitis within an umbilical hernia should be considered in the differential diagnosis for patients presenting with umbilical pain, as early administration of antibiotics and urgent surgery are essential to prevent progression to severe sepsis.