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INTRODUCTION AND IMPORTANCE: Amyand's hernia is a rare type of inguinal hernia which involves either a normal or diseased appendix within the hernia sac. We report an extremely rare case of appendiceal neuroma, presenting as an incarcerated Amyand's hernia. CASE PRESENTATION: A 55-year-old male patient presented in the emergency department due to a persistent right inguinal painful swelling. Clinical examination revealed a 5 cm × 3 cm firm and irreducible right groin mass. A diagnosis of an incarcerated right inguinal hernia was made, and the patient was prepared for surgery. Intraoperatively, a 5 cm × 3 cm firm mass originating from the distal part of the appendix was found in the hernia sac. An appendectomy and a modified Bassini hernia repair were done. The result of the histological examination revealed appendiceal neuroma, and no further surgical intervention was needed. DISCUSSION: Amyand's hernia encompasses various pathological features, including a normal, inflamed, or perforated appendix, and rarely appendiceal tumors. In the literature, we found about eight cases of malignant appendiceal tumors reported. Most of the cases indicate that the treatment of Amyand's hernia containing appendiceal tumors was an appendectomy alone, while one report with adenocarcinoma required a right hemicolectomy after biopsy result. Notably, there are no documented cases of appendiceal neuromas presenting as inguinal hernias in our search of English literature using Google Scholar and PubMed search engines. CONCLUSION: Amyand's hernia-containing appendiceal neuroma is an extremely rare entity. It is important to do histopathologic study to differentiate appendiceal neuroma from malignant tumors. In case of Amyand's hernia with appendiceal neuroma, simple appendectomy with hernia repair is adequate treatment.
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Background: Stroke is the second leading cause of death worldwide, with a significant increase in stroke burden over the last two and half decades, especially in developing countries. African countries are undergoing an epidemiological transition from being dominated by infectious diseases to being double-burdened by non-communicable diseases, with existing infectious diseases driven by sociodemographic and lifestyle changes and a weak healthcare system. Data on the risk profile, clinical presentation, and predictors of stroke subtypes are still limited. Therefore, the main aim of this study was to assess the risk profile, clinical presentation, and predictors of stroke in public referral hospitals of Northwest Ethiopia. Methods: For this study, 554 patients with stroke admitted to three public referral hospitals were prospectively followed up. Data were collected using a pre-tested interviewer-administered questionnaire. STATA version 16 was used for data analyses. Candidate variables significant in bivariate analysis were selected for multivariate binary logistic regression, and statistical significance was set at a p < 0.05. Results: Of the 554 patients with stroke, 60.3% had an ischemic stroke. The mean age of the participants was 61 ± 12.85 years, and more than half (53.25%) of them were women. The most common risk factor identified was hypertension (29.7%), followed by congestive heart failure. The most common clinical presentation was hemiparesis, which was reported by 57.7% of the patients, followed by loss of consciousness (20.7%) and aphasia (9%). Through multivariable logistic regression, age (AOR = 1.03, 95% CI:1.01-1.05), sedentary physical activity level (AOR = 6.78, 95% CI:1.97-23.32), absence of a family history of chronic illness (AOR = 3.79, 95% CI:2.21-6.48), hypertension (AOR=0.51, 95% CI:0.31-0.85), and past stroke (AOR = 3.54, 95% CI:0.93-13.49) were found to be independent determinants of the stroke subtype. Conclusion: Age, the level of sedentary physical activity, absence of a family history of chronic illness, hypertension, and past stroke were independent determinants of stroke subtype.