PMC5334518_01
Physical findings and ultrasonographic image.. (A) An irreducible mass with tenderness bulged out (6 cm in size) and was located inferior and outside the pubic tubercle in the right groin. Redness and swelling of the skin were revealed from the right groin to the anterior portion of the femoral region. (B) A tubular blind-ended structure (white arrows) medial to the femoral artery and vein. The femoral vein was displaced. FA, femoral artery; DFA, deep femoral artery.
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Moreover, redness and swelling of the skin were evident from the right groin to the anterior portion of the femoral region (Fig. 1A). Ultrasonography revealed a tubular blind-ending structure medial to the femoral artery and a displaced femoral vein (Fig. 1B).
Computed tomography image.. (A) Contrast-enhanced computed tomography (CT) scan in horizontal view revealing a tubular structure passing through the inside of the right femoral artery (white arrows). (B) The CT scan in horizontal view revealing a gas-filled subcutaneous abscess that was adjacent to the tip of the structure and spread to the anterior portion of the femoral region (white arrow heads). (C) A schema of reconstructed CT images parallel to the femoral canal. (D) The reconstructed CT images in the 8th section of (C) showing a subcutaneous gas-filled abscess (white arrow heads).
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Moreover, a subcutaneous gas-filled abscess was adjacent to the tip of the structure and spread to the anterior portion of the femoral region (Fig. 2).
Intraoperative and macroscopic findings.. (A and B) Strangulated hernia sac containing the necrotic and perforated appendix. (C) The subcutaneous abscess cavity in craniocaudal view. (D) Hernia repair with McVay's technique after appendectomy through the hernia sac. (E) The incarcerated appendix tip had marked ischemic and necrotic changes with thrombosis in the full thickness of the wall.
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When the inguinal ligament was amputated to open the femoral ring, pus was drained, and the contaminated and decaying hernia sac that contained the necrotic perforated appendix was revealed (Fig. 3A-C). An appendectomy was performed through the hernia sac and the femoral hernia was repaired using McVay's technique (Fig. 3D). Pathological examination revealed gangrenous appendicitis: the incarcerated appendix tip had marked ischemic and necrotic changes with thrombosis throughout the thickness of the wall (Fig. 3E).