Tubercular Appendicitis With Abscess In Hernial Sac- A Case Report.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 10
Abstract
A 55 year old male, presented with pain and right inguinal lump for 5 days, with long standing history of inguinal hernia. A diagnosis of obstructed inguinal hernia was made. Intraoperatively, perforated appendix with mesenteric lymphadenopathy was found, with 2 litre of pus, trickling to hernial sac, through deep inguinal ring. Sac contained no bowel contents. An appendicectomy and a modified Bassini’s repair of hernia was performed with satisfactory postoperative outcome. HPE of appendix, mesenteric lymph nodes, Pus reports and HPE of hernial sac revealed tubercular etiology. Background: Signs and symptoms of abdominal TB are nonspecific. High index of suspicion is required in detection of abdominal/peritoneal cold abscess. Tubercular appendicitis is rare and seen only in 0.1-0.3% of cases. [1] Case Presentation: A 55yr old male, presented in surgery emergency at RIMS, Ranchi , with complain of pain and swelling over right inguinal region for 5 days, and inability to reduce his hernia, which he had been doing for 25 years. On examination, he had right indirect irreducible inguinal hernia, which was not strangulated. There was no clinical or radiological evidence of intestinal obstruction. His vital signs were normal. Emergency blood reports and ultrasound abdomen was requested, which showed Hb 10.7g/dl, TLC 11400/cmm( N-55%, L39%),RBS-117mg/dl, USG whole abdomen- Rt inguinal hernia,Appendicitis andRtpyocele. A provisional diagnosis of Right obstructed inguinal hernia was made and patient was shifted to operating room after taking consent. Under general anesthesia, inguinal canal exploration was done. A large hernial sac with thick fibrous wall extending upto scrotum was found. On opening the sac, thick, white, non foulsmelling , about 2L of pus was aspirated, communicating to peritoneal cavity through deep inguinal ring. There was no contents in the sac. By separate lower midline incision, peritoneal cavity was explored, which revealed perforation at base of appendix , with no signs of ischemia/ gangrene. Few enlarged lymph nodes , about 2*2 cm were present in paracaval, mesenteric and periappendicular region. From the base of perforated appendix, pus was found to be trickling. Pus was evacuated completely, appendicectomy done, followed by thorough peritoneal wash. The anatomy of inguinal canal was distorted due to pus and necrotic tissue. Testis and cord structures were atrophied and could not be separated from hernial sac. Excision of hernial sac with (Rt) orchidectomy was done. A bassini repair of hernia was performed. Wound was closed after placement of corrugated drain.
Authors and Affiliations
Dr. Vishalprakash, Dr. Jiwesh kumar
Keywords
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- EP ID EP402393
- DOI 10.9790/0853-1710087274.
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