The De Garengeot hernia: A case report of an unusual presentation of appendicitis

Abstract

Introduction: A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases as cited by the literature.

Presentation of case: A 64-year-old female presented to the Emergency Department of our hospital with acute onset of a right-sided groin bulge that occurred earlier that day after doing heavy lifting. Her workup revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the appendiceal tip was incarcerated within the hernia sac. It was removed through the open inguinal incision after the appendix base was divided laparoscopically. Final pathology showed inflamed acute appendicitis without evidence for neoplasm.

Discussion: Physicians should be aware of the rare entity of an unusual presentation of appendicitis as well as surgical options for treatment. The literature does not conclude upon a gold standard for method of approach.

Conclusion: De Garengeot hernia remains a rare and unusual surgical presentation of femoral hernia, and complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach which should be individualized to each patient.

Keywords: Appendicitis; Appendix; De Garengeot; Femoral; Hernia; Incarcerated.

Fig. 1

Computed tomography scan demonstrating right-sided inguinal hernia—in this case, a dilated appendiceal tip within the femoral canal (De Garengeot hernia).

Fig. 2

Sagittal view showing appendiceal tip within De Garengeot hernia.

Fig. 3

Laparoscopic peritoneal view of incarcerated appendix within the femoral canal (De Garengeot hernia).

Fig. 4

Open femoral hernia repair reveals a hernia sac containing a necrotic tip consistent with likely strangulation resulting in appendicitis.