1412 De Garengeot's Hernia Complicated by Perforated Appendicitis and Groin Abscess: Report of A Rare Surgical Emergency

Introduction De Garengeot's hernia is a rare subtype of femoral hernia which contains the vermiform appendix. Acute appendicitis in a femoral hernia is even more unusual, accounting for 0.08% - 0.13% of all cases of femoral hernias. Case presentation A 91-year-old woman was referred with a painful, cellulitic right groin mass. A computed tomography scan demonstrated a right-sided femoral hernia containing a loop of bowel and a collection in the right groin containing fluid and gas. The patient had early dementia but no other major medical co-morbidities. At surgery, she was found to have perforated appendicitis in a right femoral hernia. Most of the appendix and sac had fully disintegrated, forming a large abscess cavity beneath the skin in the right groin which extended down to the upper labia majora. The appendix tip was lying deep within the abscess cavity. A modified McEvedy approach was used to access the peritoneal cavity for the appendicectomy and sutured repair of the femoral neck. The groin abscess cavity was drained and managed with a negative pressure (VAC) dressing. Discussion De Garengeot's hernia is often difficult to diagnose pre-operatively and reporting of cross-sectional imaging may not always be reliable. Currently, there is no gold standard method for repairing these hernias. However, the modified McEvedy approach is well-described and is the preferred technique for emergent femoral hernia presentations. It provides sufficient access to manage both appendicitis and the femoral hernia. Adjuncts such as negative pressures dressings may be used to manage concomitant abscess cavities.

Groin abscess, a rare complication of strangulated femoral hernia: Case report

Femoral hernias account for 8%–11% of all groin hernias and 3%–5% of all anterior abdominal wall hernias. While groin hernias are more common in males, femoral hernias are developed more commonly in female, accounting for 22%–34% of all groin hernias compared with 1.1% in male. The lifetime risk of developing groin hernia in male is approximately 25% but in female less than 5%, so in all female patients with groin hernias, femoral hernias should be included in the differential diagnosis until proven otherwise. The main concern of a femoral hernia is the higher risk of bowel strangulation, presenting emergently in 32%–39% of patients. We report a case of strangulated femoral hernia in a 78-year-old female who was presented to emergency department with groin abscess based on ultrasound image; patient was then diagnosed as having strangulated femoral hernia and taken to the operating theater, where she was found having strangulated segment of small intestine, so the patient underwent bowel resection and anastomosis with repair of the defect extraperitoneally, and ultimately, the patient improved and discharged from the hospital. Strangulated femoral hernia can present with groin abscess. Furthermore, femoral hernia should be ruled out in elderly patient presented with groin abscess, especially female patients.

Groin Abscess: Assessing The Diagnostic Accuracy Of Emergency Department Clinicians And Imaging Modalities

Objective: To determine the clinical and imaging diagnostic accuracy in adult patients presenting to the Emergency Department with groin abscess. Method: Retrospective chart review of all adult patients presenting to a district general hospital with a provisional diagnosis of groin abscess was undertaken from January 2019 to December 2019. A proforma was used to capture data such as the age, sex, co-morbidities, grade of assessing clinician and imaging profile. Results: 39 patients with a provisional diagnosis of groin abscess were identified; representing approximately 1% of all ED attendances. There were 21 males and 18 females. The age range was from 23 to 73 years (mean age 42). The abscess was located on the left side in 19 patients (49%), 18 (46%) on the right and 2 (5%) were bilateral. The overall rate of correct diagnosis of the ED clinicians compared to CT diagnosis is indicated by a sensitivity of 82%, positive predictive value of 90% and an accuracy of 75%. 22 patients had CT scan which confirmed an abscess in 18 (83%). Conclusion: Groin abscess is a rare presentation to the Emergency department. Most patients were seen by clinicians below the consultant grade. Diagnostic accuracy was highest amongst physicians.

In vitroandin vivoactivities of a bi-aryl oxazolidinone RBx 11760 against Gram positive bacteria

RBx 11760, a bi-aryl oxazolidinone was investigated for antibacterial activity against Gram positive bacteria. The MIC90(mg/L) of RBx 11760 and linezolid againstStaphylococcus aureuswere: 2 and 4,Staphylococcus epidermidis: 0.5 and 2,Enterococcus: 1 and 4, respectively. Similarly againstStreptococcus pneumoniaeMIC90was: 0.5 and 2, respectively. In time-kill studies, RBx 11760, tedizolid and linezolid exhibited bacteriostatic effect exceptS. pneumoniae. RBx 11760 showed 2-log10kill at 4 X MIC while tedizolid and linezolid showed 2 log10and 1.4-log10kill at 16 X MIC, respectively against MRSA H-29. AgainstS. pneumoniae5051, RBx 11760 showed bactericidal activity with 4.6 log10kill at 4 X MIC compared to 2.42 log10and 1.95 log10kill of tedizolid and linezolid at 16 X MIC. RBx 11760 showed 3 h post antibiotic effects (PAE) at 4 mg/L against MRSA H-29 and linezolid showed same effect at 16mg/L. RBx 11760 inhibited the biofilm production against MRSE ATCC 35984 in concentration dependent manner. In foreign body model, linezolid and rifampicin resulted in no advantage over stasis, while same dose of RBx 11760 demonstrated a significant killing from initial control againstS. aureus(*p<0.05) and MRSE (**p<0.01). The difference in killing was statistically significant for the lower dose of RBx 11760 (*p<0.05) versus high dose of linezolid (nsp>0.05) in groin abscess model. In neutropenic mouse thigh infection, RBx 11760 showed stasis at 20 mg/kg whereas tedizolid showed same effect at 40 mg/kg. These data support the RBx 11760 as a promising investigational candidate.