Acute Appendicitis in an Incarcerated Femoral Hernia: A Case of De Garengeot Hernia

Abstract

Appendicitis and incarcerated hernia are frequently encountered reasons of emergency surgery for acute abdomen. The treatment in early stages of each condition is generally simple, but when these conditions are combined, the symptoms become slightly complicated, obscuring specific symptoms. Especially the lack of symptoms for appendicitis leads to delayed diagnosis, resulting in high morbidity. Amyand hernia, which contains appendix in its inguinal hernia sac, is perhaps more familiar to the general surgeons than De Garengeot hernia, which is an incarcerated femoral hernia with an appendix in its sac. We report the case of a 90-year-old female with incarcerated femoral hernia who underwent emergency hernioplasty only to reveal an inflamed appendix in its sac. The patient underwent both appendectomy and hernia repair simultaneously with synthetic mesh and was discharged on postoperative day 7 without any complications. We will also discuss the physical and radiological findings of De Garengeot hernia.

Fig. 1

Plain pelvic CT image of De Garengeot hernia. Axial pelvic CT image shows a small round mass right beside the femoral artery and vein with the density of air and fluid (a). Intramural air and wall thickening were visualized (b).

Fig. 2

Intraoperative findings of De Garengeot hernia. The hernia sac was revealed and the content of the sac was a congested and inflamed appendix (a, b).