Itani M, El-Merhi F (2013) Subcutaneous Appendix. J Radiol Radiat Ther 1(2): 1011.

This reconstructed CT Image showing the appendix as it arises from the cecum and courses through the abdominal wall musculature, with most of it lying in the subcutaneous soft tissues of the right lower quadrant. There are many cases of herniation of the appendix through different hernias, such as inguinal hernia [1](Amyand’s hernia) and incisional hernia [2]. There are very few cases (probably four cases only) of an appendix herniating through a Spigelian hernia [3], and in all these reports the appendix was inflamed. We are presenting a case of a Spigelian hernia containing a normally outlined appendix. Our patient is a 51 year old male who presented for right flank pain. Computed tomography (CT) scan showed a stone at the right ureterovesical junction, which explains the presenting symptoms. An incidental finding was a right sided Spigelian hernia, containing a normal appendix. This weird finding has not been reported before with a normal appendix.

1. Psarras K, Lalountas M, Baltatzis M, Pavlidis E, Tsitlakidis A, Symeonidis N, et al. Amyand’s hernia-a vermiform appendix presenting in an inguinal hernia: a case series. J Med Case Rep. 2011; 5: 463.

2. Dittmar Y, Scheuerlein H, Götz M, Settmacher U. Adherent appendix vermiformis within an incisional hernia after kidney transplantation mimicking acute appendicitis: report of a case. Hernia. 2012; 16: 359- 361.

3. Reinke CE, Resnick AS. Incarcerated Appendix in a Spigelian Hernia. JSCR. 2010; 10: 3.