A rare case of locally advanced mucinous adenocarcinoma of the appendix confined in the inguinal canal: Clinical presentation, operative management.

Abstract

Background: An Amyand’s hernia is a right inguinal hernia that contains the appendix in the hernia sac. Mucinous adenocarcinoma of the vermiform appendix is a rare neoplasm commonly discovered through the histology report of a presumed appendicitis specimen or as the cause of pseudomyxoma peritonei. It is very rare for the two entities to co-exist and present as an incarcerated right inguinal hernia. Case Summary: We report a rare case of a mucinous appendiceal adenocarcinoma that ruptured towards the confided anatomical space of the inguinal canal. Initial presentation of the patient was with small bowel obstruction and clinical examination revealed a co-existing right inguinal hernia. Exploratory laparotomy findings revealed an appendiceal mucinous adenocarcinoma invading the adjacent bowel loops and identified an encapsulated collection of mucinous material extended into the inguinal canal and lateral abdominal wall. He underwent a right hemicolectomy with excision of the adjacent small bowel loops and the affected abdominal wall. Conclusion: As the patient presented with a long-standing history of inconsistent symptoms, he underwent thorough preoperative investigations which revealed the true extend of the underlying disease and led to appropriate surgical intervention. The fact that the tumour extended towards the confided space of the inguinal canal prevented the development of pseudomyxoma peritonei. It remains to be examined if such cases, where the mucinous material is contained bare a favourable prognosis.