Ultrasound Assisted Diagnosis of Incarcerated Appendix in Spigelian Hernia.

Abstract

**Introduction:** There have only been 9 cases of Spigelian hernias containing incarcerated vermiform appendix in the medical literature. Prior to our case, only one other case was diagnosed with ultrasound. **Case Report:** We report an ultrasound guided diagnosis of an incarcerated appendix within a Spigelian hernia in a 72-year-old female. Ultrasound expedited the patient’s care by avoiding CT scan protocol. Upon laparoscopic evaluation the appendix was visualized within the hernia and photographed, we converted to an open appendectomy with a hernia repair without mesh to avoid contamination. She did very well post operatively and had no signs of recurrence or other complications several months after the operation. **Conclusion:** Incarcerated appendix within Spigelian hernia is a once in a lifetime experience for a general surgeon. Ultrasound has been shown now in two reported cases to assist in the diagnosis of this rare entity. Tissue repair as we performed for this type of hernia avoids the risk of infected mesh.