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SECTION EDITOR: CARL E. BREDENBERG, MD
The computed tomographic scan findings were consistent with an incarcerated right inguinal hernia with acute appendicitis in the hernia sac. A laparoscopic appendectomy was performed, an inflamed internal ring was found, and a temporary repair was performed by dissecting and suturing a portion of the adjacent lateral vesicoumbilical ligament to the internal inguinal ring (Figure 3).
A 1-cm T1a appendiceal carcinoid tumor was found. The patient returned to the operating room 6 weeks later for exploratory laparoscopy; no additional evidence of malignancy was found, and the primary hernia repair was adequate. He underwent a formal transabdominal preperitoneal repair with mesh, and his recuperation was uneventful.
Image of the Month—Diagnosis. JAMA Surg. 2013;148(6):574–575. doi:https://doi.org/10.1001/jamasurg.2013.304b
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