10/9/20

Case of a 67year old male with recurrent right inguinal hernia. Patient is a known hypertensive on medication . He had right inguinal hernia repair done 15 years ago and was  well until he noticed a swelling in the right groin in past 3 years . Swelling was reducible by patients effort . he had discomfort in the groin but no remarkable pain.

Patient did not have any noticeable lower urinary tract symptoms . Ultrasound oif the bladder ,prostate ,

kidneys

haematologic investogation

The cause of recurrence was not  attributable to bladder outlet pathology.

Diagnosis : Reducible recurrent right inginal .

Patient was councelled for hernia repair

Routine preoperative labs and anaesthetic evaluation was done and patient was cleared for surgery

Operative details 

Supine position

Spinal anaesthesia

Groin prepared with chlorhexidine solution and draped.

Right oblique incision placed over previous scar and deepened to the subcutaneous tissue.

Dissection carries to the cord which was mobilized and slinged.  Sac was identified and dissected revealing a tip of the appendix. The proximal extent of the incision extended. Fibers of internal oblique divided.  Peritoneum divided and caecum mobilised.

Appendicular artery ligated and divided between haemostat. Apppendicectomy completed.

Peritoneum repaired with Vicryl 2/0.

Internal oblique muscle repaired with Vicryl 0.

Internal ring refashioned with Vicryl 0.

External Oblique aponeurosis repaired.

Subcutaneous apposition dome to repair dead space.

Skin closure done with Nylon 2/0.

Findings : 

8cm long appendix with thickened wall. the base of caecum was normal.

Findings

Amyand hernia with enlarged vermiform appendix (8cm in length, 2cm diameter) with fibrotic tissue.

Cord structures including vas deferens identified and isolated.

Procedure

Post-operative management

I V antibiotics

IV analgesia

Send Specimen for histopathology.

Patient to be admitted andmonitored in the ward overnight.

Resume normal feeding when he has recovered from anaesthesia.

Postoperative review

Patient made excellent recovery and was discharged within 24hrs .

Surgeon :Dr Richard Ametih ( urology resident)

Assistant : Dr Nana Yaa Asare ( Medical officer )