RESUMEN
Amyand's hernia refers to a rare occurrence in which the vermiform appendix, either inflamed or normal, happens to be found in an inguinal hernia sac. Due to its rarity and unspecific clinical evidence, it is most commonly presented as an intra-operative finding. A laparoscopic approach becomes both a way to confirm the diagnosis and a therapeutic tool. Case report: We hereby report a case of a 62-year-old patient presenting with an asymptomatic bilateral inguinal hernia, previously treated on his right side in 2011 with an open approach. The elective laparoscopic surgery, during the right groin exploration, revealed a vermiform appendix, with no signs of inflammation, within the hernia sac. . A prosthetic laparoscopic hernioplasty without appendicectomy was performed and both early outpatient follow-up and 30-day outcome demonstrated excellent recovery. Conclusions: Appendicectomy, when necessary, and primary hernia repair at the same time can be safely performed by laparoscopy which may be considered an advantageous management giving its role in diagnosing, in confirming an Amyand's hernia, in exploring the abdominal cavity and in being a therapeutic tool at the same time(AU)
La hernia de Amyand se refiere a una ocurrencia rara en la que el apéndice vermiforme, ya sea inflamado o normal, se encuentra dentro de un saco inguinal herniario. Debido a su rareza y evidencia clínica inespecífica, se presenta más comúnmente como un hallazgo intraoperatorio. Un abordaje laparoscópico se convierte tanto en una forma de confirmar el diagnóstico como en una herramienta terapéutica. Caso clínico: Presentamos un caso de un paciente de 62 años que presenta una hernia inguinal bilateral asintomática, previamente tratada en su lado derecho en 2011 con un abordaje convencional abierto. La cirugía laparoscópica electiva, durante la exploración de la ingle derecha, reveló un apéndice vermiforme, sin signos de inflamación, dentro del saco de la hernia. Se realizó una hernioplastia laparoscópica protésica sin apendicectomía y tanto el seguimiento ambulatorio temprano como el resultado a 30 días demostraron una excelente recuperación. Conclusión: La apendicectomía, cuando es necesario, y la reparación de la hernia primaria al mismo tiempo se pueden realizar de forma segura por laparoscopia que puede considerarse una gestión ventajosa dando su papel en el diagnóstico, en la confirmación de una hernia de Amyand, explorando la cavidad abdominal y siendo una herramienta terapéutica al mismo tiempo(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Apendicectomía , Cuidados Posteriores , Cavidad Abdominal , Hernia Inguinal , Signos y Síntomas , LaparoscopíaRESUMEN
BACKGROUND: Merkel cell carcinoma (MCC) is a neuroendocrine malignant neoplasm that usually has its primary location on the skin. It often metastasizes to lymph nodes, liver, lungs, bones and brain. Actually there have been few cases of MCC of the retroperitoneal region without a primary skin lesion. CASE PRESENTATION: Our case is a male of 55 year old who initially underwent a partial resection (R1) of a bulky pelvic mass; the histopathological analysis and the immunoistochemistry showed the presence of neuroendocrine Merkel cells. The patient underwent 6 cycles of postoperative chemotherapy (carbon platinum and etoposide) and adjuvant radiotherapy. Afterwards the patient underwent surgery again with the complete resection of the tumour. DISCUSSION: The histopatological and immunoistochemistry analysis of the first and the second surgical samples confirmed the diagnosis of a retroperitoneal high-grade neuroendocrine carcinoma with a high mitosis index. The immunoistochemistry profile showed neoplastic cell with: CD 20+, synaptophysin +, TTF-1-, neurofilaments +, CK 7-, chromogranin, Ki67 90%. In the patient's medical history no skin localizations were mentioned. CONCLUSION: The hypothesis of a MCC with a primary retroperitoneal localization has been strength by the histopathological and immunoistochemistry analysis of two intra-operative samples from two different surgical procedure and from the absence of either a primary skin location or of secondary recurrences. Is therefore reinforced the theory that from a cell into a retroperitoneal lymph node can arise a retroperitoneal mass originating a Merkel cell tumour.