Title : The utility of intraoperative ultrasound in the localization of post-open appendectomy interstitial incisional hernia: A case report
Abstract:
Acute appendicitis is the leading abdominal emergency in the United States, affecting approximately 90 to 100 individuals per 100,000 annually, and appendectomy is among the most frequently performed surgical procedures, with more than 300,000 operations conducted each year. In open appendectomy using the McBurney incision, the occurrence of incisional hernia is rare, seen in less than 0.12% of patients.
Here, we present the case of a 59-year-old woman who came in with a painful bulge in the right hemiabdomen, located above her previous McBurney incision, following an appendectomy eight months earlier. Preoperative ultrasound and CT scans led to a diagnosis of an interstitial hernia. During surgery, the exact location of the defect was difficult to localize, so an intraoperative ultrasound was conducted. The defect was then repaired with mesh through an open surgical approach.
Incisional hernias following an open appendectomy via the McBurney incision are uncommon. Two types of incisional hernias can occur post-appendectomy. The more common type involves the hernia traversing all layers of the abdominal wall. The less common type, known as the interstitial hernia, occurs when the hernia passes through a defect in the transversus abdominis and internal oblique muscles, while the aponeurosis and muscles of the external oblique remain intact. One anatomical factor contributing to the development of the latter is the obliteration of the transversalis fascia in the area.
Interstitial hernias can be easily missed, and ultrasonography of the abdomen or non-contrast CT of the abdomen can help confirm the diagnosis. However, in cases where there is no noticeable bulge or palpable defect in the external oblique aponeurosis, intraoperative ultrasound can help locate the defect and hernial sac, preventing incorrectly placed incisions.
