# Internal Hernia as a Rare Complication of Acute Appendicitis

## TL;DR

A rare case of internal hernia caused by acute appendicitis was diagnosed through laparoscopy in a 47-year-old woman.

## Contribution

This case highlights the rare complication of internal hernia associated with acute appendicitis.

## Key findings

- The appendix was inflamed and attached to the cecum, forming a ring-like structure.
- An internal hernia involving the terminal ileum was identified during laparoscopy.
- Diagnostic imaging was inconclusive, emphasizing the need for skilled surgical intervention.

## Abstract

Appendicitis is a well-known and highly common surgical emergency disease, yet it presents with a wide variety of manifestations. This is a case report of a 47-year-old female who presented with a complaint of having constant crampy right lower abdominal pain for two weeks. The patient reported having a sudden onset of symptoms that went with the typical picture of acute appendicitis that occurred two weeks ago. Our pre-op workup was inconclusive; therefore, we planned to go for a diagnostic laparoscopy, where surprisingly, the appendix was long, inflamed, and attached to the posterior wall of the cecum. Thus, a ring-like structure was developed, in which 8 to 10 cm of the terminal ileum (the last part of the small bowel) was going through and causing an internal hernia. Although blood and radiology workups provide valuable assistance in diagnosing common cases, a highly suspicious sense and skillful surgeons with good clinical experience play a major role in managing such rare presentations.