Littre hernia is the protrusion of a Meckel diverticulum through a potential abdominal opening. Alexis de Littre (1700) reported ileal diverticula and attributed them to traction. August Gottlieb Richter (1785) defined them as preformed, and Johann Friedrich Meckel (1809) postulated their embryologic origin. Sir Frederic Treves (1897) distinguished between Littre and Richter hernia (partial enterocele). Embryologically, Meckel diverticulum is the persistent intestinal part of the omphaloenteric duct through which the midgut communicates with the umbilical vesicle until the fifth week. It is found at the antimesenteric border of the ileum, usually located 30 to 90 cm from the ileocecal valve, measuring 3 to 6 cm in length and 2 cm in diameter. Usual sites of Littre hernia are: inguinal (50%), umbilical (20%), and femoral (20%). Meckel diverticulum may be accompanied in the sac by the ileal loop to which it is attached; rarely, it may undergo incarceration or strangulation, necrosis, and perforation. In children, it is mostly found in umbilical hernias, and the diverticulum is more prone to adhere to the sac. Repair of Littre hernia consists of resection of the diverticulum and herniorraphy; in perforated cases, care must be taken to not contaminate the hernia field.

Littre Hernia: Surgical Anatomy, Embryology, and Technique of Repair:

AIM: To document unusual findings in appendectomy specimens.

METHODS: The clinicopathological data of 5262 patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English language studies published between 2000 and 2010 on unusual findings in appendectomy specimens.

RESULTS: Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed with tuberculous appendicitis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed.

CONCLUSION: Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review

Amyand’s hernia is an extremely rare condition in which the appendix is positioned in the inguinal hernia sac Acute appendicitis is much less common in this situation and few reports are found in the

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Amyand's Hernia - Case Report and Review of the Literature.

Amyand's hernia is defined as when the appendix is trapped within an inguinal hernia. While the incidence of this type of hernia is rare, the appendix may become incarcerated within Amyand's hernia and lead to further complications such as strangulation and perforation. Incarceration of the appendix most commonly occurs within inguinal and femoral hernias, but may arise to a lesser extent in incisional and umbilical hernias. Incarcerated appendix has been reported in a variety of ventral abdominal and inguinal locations, yet its indistinct clinical presentation represents a diagnostic challenge. This paper reviews the literature on incarceration of the appendix within inguinal hernias and discusses current approaches to diagnosis and treatment of Amyand's hernia and complications that may arise from incarceration of the appendix within the hernia.

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Amyand's hernia: A review

BACKGROUND: The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand’s hernia. The aim of this systematic review was to gather information concerning its prevalence, clinical image, diagnosis, and treatment. DATA SOURCES: The MEDLINE database was thoroughly searched using the keyword ‘‘Amyand’s hernia.’’ Additional articles were gathered and evaluated. CONCLUSIONS: The true prevalence of Amyand’s hernia seems lower than classically described. Its usual clinical image is identical to that of an incarcerated hernia, and thus it is almost impossible to diagnose preoperatively, although ultrasound and computed tomography can help. Treatment includes hernioplasty with or without appendectomy and/or mesh repair depending on the vermiform appendix’s inflammation status, the patient’s general condition, and other factors. Amyand’s hernia generally has a good prognosis, although serious complications have been described. Surgeons should be prepared if they encounter Amyand’s hernia because appropriate treatment ensures hernia repair without complications and with avoidance of recurrence.

http://lib.ajaums.ac.ir/booklist/1-s2.0-s0002961013006466-main.pdf

Amyand's hernia: a review

We report an extremely rare case of complicated Amyand's hernia. A 61-year-old male patient was admitted with clinical signs of incarcerated right inguinal hernia and localised tenderness in the right iliac fossa. He underwent emergency surgery and the operative findings included perforated appendix and periappendicular abscess within a right inguinal hernia sac. Appendectomy and Shouldice's herniorrhaphy without prosthetic mesh placement were performed. Histology revealed the presence of a villous adenoma near the base of the appendix. We point out that although Amyand's hernia is a very rare clinical entity, it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia, especially when there are no pathological findings on the abdominal X-rays.

Perforated appendix and periappendicular abscess within an inguinal hernia

Segmental liver incarceration through a recurrent incisional lumbar hernia.

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Right diaphragmatic rupture and hepatic hernia: a rare late sequela of thoracic trauma.

Cystic lesions of the adrenal gland are rare clinical entities, with a reported incidence of 0.064% to 0.18% in autopsy studies and 5–6% in clinical series. In most cases, adrenal cysts are non-functional. A 45-year-old man was admitted with a 2-month history of abdominal discomfort and dull pain mainly in the right hypochondrium. Physical examination revealed a large non-tender mass in the sub-hepatic area. A computed tomography (CT) scan showed a large cystic mass of the right abdomen compressing the right lobe of the liver and right kidney. Magnetic resonance imaging (MRI) showed a large cystic thin-walled homogeneous mass originating from the right adrenal gland. The mass was compressing the liver, the right kidney and the inferior vena cava (Figs 1,2). Since an adrenal lesion was considered, a careful hormonal work-up was performed, which was negative. During surgery, the patient was placed in the left lateral decubitus position. Laparoscopy was performed with the open Hasson technique at the umbilical level, while two additional 5-mm trocars were introduced: one in the right mammary (midclavicular) line, 3 cm below the coastal margin and one in the anterior axillary line. The peritoneal reflection of the right triangular ligament of the liver was divided and the hepatic flexure of the colon was mobilized. The lesion was then noted, but we could not grasp it due to the tension of its content. The cyst was punctured and a large amount of serous fluid was aspirated. The cystic fluid was sent for cytologic analysis, but there was no evidence of malignant cells. The collapsed cyst was retracted outward and a wide unroofing was performed in order to preserve the adrenal parenchyma. Intraoperative frozen section examination revealed no evidence of malignancy. After a careful haemostasis, a drain was placed to the operating site and the trocar sites were closed using absorbable sutures. The patient had an uncomplicated post-operative course. Histological findings were suggestive of an adrenal pseudocyst without an endothelial or epithelial lining, whereas some calcifications were noted (Fig. 3). The patient remains well and asymptomatic 9 months after surgery. The first case of an adrenal cyst was described by the Viennese anatomist Greiselius in 1670. Adrenal cysts are histologically classified into four categories: endothelial cysts (45%), pseudocysts (39%), epithelial cysts (2%) and parasitic cysts (7%). Although they can occur at any age, they do, however, occur more frequently in the fourth and fifth decades of life and affect mainly women with a female-to-male ratio of 2–3:1. In 34% of the cases, the diagnosis is made incidentally, whereas only 56% of the cases are correctly

Konstantinos Nisotakis

Papers

Perforated appendix and periappendicular abscess within an inguinal hernia

Segmental liver incarceration through a recurrent incisional lumbar hernia.

Right diaphragmatic rupture and hepatic hernia: a rare late sequela of thoracic trauma.

Giant adrenal pseudocyst: laparoscopic management.

Images in cardio-thoracic surgery Right diaphragmatic rupture and hepatic hernia: a rare late sequela of thoracic trauma