Appendicitis within an incisional hernia is rare, with current literature describing a small number of cases, occurring through a variety of surgical incisions. We describe a case of appendicitis contained within an incisional hernia following reversal of a loop ileostomy, on a background of previous sigmoid cancer resection. This is the second such case we were able to identify on literature review. A 45 year old man presented with one day of migratory abdominal pain, predominantly focused at a tender, irreducible lump in his right lower quadrant, underlying the scar from previous reversal of loop ileostomy. CT on admission revealed an incisional hernia, containing an inflamed appendiceal tip. He underwent an uncomplicated laparoscopic appendicectomy and primary suture closure of the hernia defect, and was discharged the following day. Acute appendicitis was confirmed on histopathology. Placement of a defunctioning ileostomy is common in the management of colonic cancers, and incisional hernias are a common complication. It is however rare for an appendix to be contained within a hernia sac, and even rarer for appendicitis to develop in this setting. As a result, the presentation of this condition may mimic that of an incarcerated or strangulated incisional hernia, with pre-operative diagnosis typically relying on diagnostic imaging. Incisional hernia appendicitis is rare and presents a diagnostic challenge. Early recognition of this dual pathology is necessary to allow for prompt surgical management of both the appendicitis and hernia, as well as guiding the approach for hernia repair. Sacral osteoid osteoma (OO) is a rare location. The clinical signs are misleading, hence the delay in diagnosis. Through this case, we will put. The aim of this work was to put the light on a clinical sign that may suggest the diagnosis of OO and to report the therapeutic management. We report the case of an OO located in the left lamina of the first sacral vertebra, revealed by pain in the sacroiliac joint mimicking sacroileitis in a 12-year-old child. Computed tomography and MRI revealed bone lysis in the left lamina of the first sacral vertebra consistent with the diagnosis of OO. Anatomopathological examination of the resection piece confirmed the diagnosis. Surgical removal of the tumor resolved the pain.

With Regards,
Sara Giselle
Associate Managing Editor
Global  Journal of Digestive Diseases