De Garengeot hernia: a systematic review

Abstract

Background: A De Garengeot hernia is a femoral hernia that contains the appendix. This rare type of hernia was first described by René-Jacques Croissant De Garengeot in 1731. Numerous case reports have been published since then, yet collective analysis about the presentation, diagnosis, management, and outcomes of patients with this unique hernia is lacking.

Methods: A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science for cases of De Garengeot hernias. Keywords searched included "De Garengeot hernia" OR "femoral appendicitis" OR "femoral hernia appendix" OR "crural hernia appendix." To facilitate review, a classification system was created based on the gross appearance of the appendix and related structures in the femoral hernia.

Results: Two hundred and twenty-two cases were identified in 197 manuscripts. Cases most commonly came from Europe but have been reported worldwide. There was a female predominance (n = 180, 81.1%) and the mean age at presentation was 69.8 years. The most common presenting symptoms were a groin bulge and groin tenderness (82.4%, n = 183 and 79.7%, n = 177, respectively). A groin bulge was observed on physical exam in 95.0% (n = 211) of cases, and erythema over the hernia was present in 33.3% (n = 74). A pre-operative diagnosis of a De Garengeot hernia was established with imaging in only 31.5% (n = 70) of cases. The most common surgical approach was through a groin incision. Complications occurred in 9.5% (n = 21) of cases, most commonly surgical site infections. The most common condition of the appendix was congested/inflamed, found in 44.1% (n = 98) of cases and corresponding to class 2A in the classification system devised.

Conclusions: Overall, De Garengeot hernias were found to be rare and clinically heterogeneous, as highlighted by our classification system. A systematic approach to categorizing this unique hernia may improve management decisions and help avoid complications.

Keywords: Crural hernia appendix; De Garengeot hernia; Femoral appendicitis; Femoral hernia appendix.

Fig. 1

Pre-operative computed tomography showing the appendix (white arrow) within a right-sided femoral hernia

Fig. 2

An intraoperative image showing the relationship of the incarcerated hernia sac to the inguinal ligament, thus confirming the diagnosis of a femoral hernia

Fig. 3

An intraoperative image showing an erythematous appendix found within the femoral hernia, thus confirming diagnosis of a De Garengeot hernia

Fig. 4

Flow diagram of systematic review for cases of De Garengeot hernias

Fig. 5

Age distribution for cases of De Garengeot hernias based on sex

Fig. 6

Distribution of cases of De Garengeot hernias based on decade