Saturday, March 18, 2006

Interesting ct of the abdomen. What's in the right side? Posted by Picasa

posted by joe @ 3/18/2006 03:24:00 PM   6 comments


At 9:36 PM, Blogger Clay said...

Looks rather vermiform.

By the way, its a CT of a pelvis.

At 10:17 PM, Blogger joe said...

Well, it was ordered as a ct of the abdomen. So what is "worm-like"?

At 10:36 PM, Blogger Clay said...

That is a vermiform appendix in an inguinal hernia.

At 7:19 AM, Blogger joe said...

Correct!!(as ususal)In discussion with local a surgeon, he says it is not uncommon to find an appendix in a inguinal hernia, and that this case does have to have surgery. He has found the entire cecum in a hernia before. Most people (and I think he would also) would remove the appendix and repair the hernia before it became acute. An acute appendix in a hernia is called an Amyand's hernia(good article on Google). Reports of hernias with Meckel's, appendix in femoral hernias, and appendix on the LEFT inguinal hernia are there.
This is the first time I had seen one and the patient was without pain in his inguinal region.

Oh, by the way did we discuss this on the way to Memphis or was I talking in my sleep on the way back?

At 10:37 AM, Blogger Clay said...

I had never heard of this particular case. I don't think I would have gotten it based soley on the information you intentionally gave us. The key to my diagnosis was looking at the file name of picture you posted.

I won't be giving away any more of my secrets so easily from now on.

At 4:47 PM, Blogger joe said...

Glad you are honest--by the way BB told me your secret. I did label the picture, but when I posted it didn't see the label--not suprised that the blogmaster could see it though.

Another surgeon today said it was more uncommon than the first. This cutter is one with more experience and he has only seen it once. He said it would be a concern to remove the appendix and repair the hernia with mesh(concern about infecting the mesh). He would do a old repair without mesh(removal of the hernia sac).


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