Abstract
A case of incarcerated inguinal hernia in which a perforated appendicitis with purulent peritonitis is reported. A 69-year-old man presented with a painful mass in the right side of groin, which was not associated with nausea and vomiting. White blood cell count and C-reactive protein were moderately elevated. Abdominal X-ray films showed mild distention of the small intestine but no evidence of obstruction. Abdominal ultrasonography above the inguinal bulge showed fluid retention and an appendix-like structure protruding from the right internal inguinal ring. A diagnosis of right incarcerated inguinal hernia was made and an emergency operation was performed. The hernia sac was tense and thickened with inflammation. The sac was opened to reveal an inflamed appendix adhered to the sac. An appendectomy was performed easily after enlarging the internal inguinal ring with a primary repair of the inguinal hernia. The patient had an uneventful postoperative course. This condition is so rare that we clinicians find a great deal of difficulty in making accurate diag-nosis preoperatively. However, present illness of tender inguinal hernia without ileus symptoms and abdominal ultrasonography above the inguinal bulge should be helpful for the accurate preoperative diagnosis.
