Acute appendicitis of the elderly in a hernia of Petit. Report of a case

Abstract

Introduction: Lumbar hernias represent 2 % of the total ventral hernias. Petit's hernia belongs to the group of congenital lumbar hernias occupying 10 % of them. The hernia defect is at the level of the lower lumbar triangle, limited by the iliac crest as the base, the external oblique muscle as the lateral border and the broad dorsal muscle as the medial border. There are no reports of the presence of acute appendicitis within a hernia of this type. We present the case of a patient with acute appendicitis in a Petit hernia. Case report: Male, 80 years old. He started with persistent, non-specific and diffuse abdominal pain with an evolution of a month, accompanied by non-quantified hyperthermia, anorexia, difficulty in channeling gas and constipation. At the physical examination, he revealed moderate abdominal distension, decreased bowel sounds, positive rebound, and frank muscular resistance throughout the abdomen. A 5 × 5 cm lump was observed. It was hard and not reducible; very painful at palpation. The diagnosis of a strangulated lumbar hernia was established and surgical exploration and lumbar hernioplasty were scheduled, finding the appendix with an acute inflammation, abscess and an omentum plas-tron within a hernia sac through a small hernia defect. He also presented generalized purulent peritonitis, deciding to perform an exploratory laparotomy to check and wash the rest of the cavity, appendectomy and primary closure of the aponeurotic defect due to contamination. The histopathological study showed an acute perforated appendicitis (grade IV). After a year it was observed a favorable evolution without a recurrence. Discussion: An acute appendicitis associated with a Petit's hernia is an exceptional diagnosis.