P-011 OPEN PREPERITONEAL APPROACH IN AN INCARCERATED ABSCESSIFIED GARENGEOT HERNIA

Abstract

Abstract Aim The Garengeot hernia is a a rare entity (incidence 0.15–5%) that appears more frequently in elderly women and contents the vermiform appendix. Different surgical approaches are available but the most appropriate one is unknown. Association or conversion to laparotomy may be needed in complicated cases entailing higher morbimortality. Results 82-year-old female with hypertension, dyslipidemia and left inguinal hernioplasty. She presented acute right inguinal pain with a 1 month of evolution mass associated extended to the limb. Blood tests were normal but CT scan was performed reporting a right incarcerated inguinal hernia with acute perforated and abscessified appendicitis. Besides antibiotics, an open preperitoneal approach was performed. An incarcerated crural hernia was found: the sac was opened, the perforated appendix was reduced and the abscess was debrided. Appendicectomy was performed and after aseptic measures and critical view, a 15×15cm gentamicin impregnated large-pore light-weight polypropylene mesh was placed in the preperitoneal space covering the myopectineal orifice. Patient was successfully discharged 4 days after surgery with no complications after two years of follow-up. Conclusion The treatment of a complicated crural hernia in a septic environment in the emergency room represents a challenge. In an incarcerated and abscessified Garangeot hernia, an open preperitoneal approach (modified Nyhus technique) can be safely performed to confront both pathologies. Not only it allows access to the abdominal cavity through a small incision, avoiding the need for a laparotomy, but also favours an optimal exploration and repair of the myopectineal orifice.