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Case Reports
. 2013 May-Jun;34(5-6):158-60.
doi: 10.11138/gchir/2013.34.5.158.

Can herniation pit of the femoral neck mimic an acute appendicitis? A case report

A Volpi, O C Pannarale, G Mancusi Materi, V Favia, A Panebianco, A Prestera, P Ialongo, S Giungato, R Lozito, N Palasciano
Case Reports

Can herniation pit of the femoral neck mimic an acute appendicitis? A case report

A Volpi et al. G Chir. 2013 May-Jun.

Abstract
in English, Italian

Although in most cases the diagnosis of acute appendicitis is straightforward, not all patients experience typical symptoms and other conditions may mimic appendicitis. In fact, 15-25% of appendectomies involve the removal of a normal appendix. To date, there is no literature evidence that herniation pit (HP) may mimic acute appendicitis. We report a case of a 30 year old woman admitted to the Emergency Department for severe, acute pain developing a few hours earlier in the lower right fossa, with irradiaton to the right thigh. She did not present any fever, nausea or vomiting, Blumberg's sign was absent but the psoas sign and obturator sign were both positive. WBC count was 16,000/mm3 and the Alvarado score was 4. Biochemistry profile was normal. US was unclear and transvaginal ultrasound did not show any gynecological disease. CT scan showed only an herniation pit of the right femoral neck. The patient was admitted to an orthopedic ward and treated with anti-inflammatory therapy. She was discharged after 2 days without any pain and in good conditions. Our case demonstrates that herniation pits of the right femoral neck should be considered a potential cause of right lower abdominal pain mimicking acute appendicitis, particularly if the psoas sign and obturator sign are positive and the patient is physically active.

Sebbene nella maggior parte dei casi la diagnosi di appendicite acuta sia semplice, non tutti i pazienti mostrano i tipici sintomi, anche perché altre condizioni possono mimare una appendicite. Infatti nel 15–25% dei casi viene rimossa chirurgicamente una appendice normale. Al momento non ci sono in letteratura pubblicazioni riguar-danti l’herniation pit del collo femorale che mima una appendicite acuta. Viene riportato il caso di una giovane donna di 30 anni ricoverata presso la Chirurgia d’urgenza per dolore acuto ed intenso in fossa iliaca dx, irradiato al fianco omolaterale, insorto da poche ore. La paziente non presentava né febbre, nè vomito o nausea; il segno di Blumberg era negativo con segno dell’otturatore e dello psoas entrambi positivi. I globuli bianchi erano 16,000/mm3 e lo score di Alvarado era 4. Gli esami di laboratorio erano nella norma. Una ecografia addominale eseguita risultava poco chiara; una consulenza ginecologia con ecografia trans vaginale non evidenziavano patologie ginecologiche in atto. Una TAC mise in evidenza una herniation pit del collo femorale dx. La paziente pertanto, fu trasferita in ortopedia e sottoposta a terapia antiinfiammatoria. Fu dimessa dopo 2 giorni, senza dolore addominale, in buone condizioni. Il caso dimostra che l’HPs del collo femorale dx può essere considerata una potenziale causa di dolore in fossa iliaca dx e mimare una appendicite acuta, soprattutto se sono positivi i segni dello psoas e dell’otturatore e la paziente è fisicamente attiva.

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Figures

Fig. 1
Fig. 1
CT showing herniation pit on the right femoral neck.
See this image and copyright information in PMC

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