Treatment of de Garengeot's hernia: a meta-analysis

Surgical Approach in Management of Acute Appendicitis Within a De Garengeot Hernia: A Case Report

De Garengeot hernias are rare surgical occurrences and even more so when the histopathology reveals acute appendicitis. Varying approaches are documented with regards to open versus laparoscopic and the use of mesh. This case demonstrates the successful use of an open high McEvedy approach with primary suture closure in an elderly female who presented with an acute history of a right groin lump, right iliac fossa pain, nausea and fever.

A case report and literature review of De Garengeot hernia

The presence of an appendix in the femoral hernia, known as De Garengeot hernia, was first described by a French surgeon named Rene Jacques Croissant de Garengeot in 1731. It is a rare surgical entity occurring in only 0.5-5% of all femoral hernias. It presents typically as an irreducible lump in the groin which may be difficult to differentiate from incarcerated inguinal hernia. The risk of incarceration is high due to the narrow femoral defect which can result in extraluminal compression of the appendix causing acute appendicitis. We have presented a 71-year-old woman with a 24 hour history of incarcerated De Garengeot hernia who underwent successful open femoral hernia repair with laparoscopic appendicectomy. While open femoral hernia repair with open appendicectomy is regarded as the commonly used surgical approach, we have highlighted the importance of pre-operative and intra-operative findings in predicting definitive surgical management.

De Garengeot Hernia: A Case Report of an Incidental Finding

De Garengeot hernia is a rare occurrence characterised by the presence of the appendix within a femoral hernia. This type of hernia is notable for its rare anatomical presentation. In rare instances, the appendix can present as inflamed or necrotic in which case it may present as an emergency. In many instances, De Garengeot hernia is discovered incidentally during surgical repair of a hernia. This incidental finding raises an important consideration for surgeons. This study reports a case of De Garengeot hernia identified as an incidental intraoperative finding. It aims to enhance awareness of the condition, ultimately improving patient outcomes and management.

De Garengeot hernia: A unique presentation of femoral hernia with perforated appendicitis

INTRODUCTION

De Garengeot hernia is a rare subset of femoral hernias containing the vermiform appendix. It is more common in females. The presenting symptoms are non-specific hence diagnosis is challenging and there is no consensus on treatment of it.

PRESENTATION OF CASE

An 85-year-old male patient who had previously undergone herniorrhaphy presented with a four-day history of pain and swelling in the right groin region. On a contrast-enhanced computed tomography scan it revealed incarceration of the appendix within femoral hernia. It was managed with appendectomy and closure of the defect using non-absorbable suture.

DISCUSSION

Diagnosis of De Garengeot hernias remains challenging due to their non-specific presentation and attenuated clinical symptoms, often leading to intraoperative identification. It is crucial for physicians to recognize this rare presentation of appendicitis and be familiar with the available surgical interventions. However, the literature does not establish a consensus regarding the preferred surgical approach.

CONCLUSION

De Garengeot hernia remains an uncommon and challenging presentation of femoral hernia, particularly when complicated by appendiceal incarceration leading to acute appendicitis. Surgical management should be tailored to each patient's unique circumstances.

Strangulated Femoral Hernia Containing Perforated Appendicitis and Perforated Small Bowel (De Garengeot Hernia): A Case Report

A femoral hernia containing the appendix within the sac is known as De Garengeot hernia. This condition is relatively rare but is important to recognize because it combines the complications of both femoral hernia and acute appendicitis, which are two distinct surgical emergencies. Clinical findings of a strangulated or incarcerated hernia may obscure signs of acute appendicitis. The presence of the inflamed appendix within the femoral hernia sac complicates the management of both conditions and requires careful surgical planning. We report a case of an 87-year-old female with De Garengeot hernia, complicated by perforated appendicitis and strangulated small bowel with perforation.

Laparoscopic surgery for De Garengeot's hernia in a man after inguinal hernia surgery with a mesh plug: a case report and review of literature

BACKGROUND

De Garengeot's hernia is a rare case of a femoral hernia that contains the appendix. Here we report a case of De Garengeot's hernia that occurred in a male patient who had a history of inguinal hernia surgery using a mesh plug. There were no reports of De Garengeot's hernia with a history of surgery for inguinal hernia, and the surgical question was whether we could successfully treat a patient with minimally invasive laparoscopic surgery using a mesh.

CASE PRESENTATION

This case involved 75-year-old man with a history of right indirect inguinal hernia surgery using a mesh plug without on-lay mesh, who presented with a 5-day history of a right groin lump. Abdominal CT revealed an incarcerated appendix within the right femoral hernia and fluid collection around the appendix. Laparoscopic surgery was initiated and the incarcerated appendix was released with traction. There was no contamination around the appendix or the femoral ring, the appendix was removed, and the femoral hernia was repaired using mesh. Laparoscopic surgery was useful in first evaluating the inflammatory status of the appendix. As it was determined that there was little inflammation around the appendix and femoral ring, it was possible to repair the hernia using mesh.

CONCLUSIONS

De Garengeot's hernias are rare and there is currently no standardized approach. Even if it is a recurrent hernia in the groin, laparoscopic surgery can be useful for diagnosis and treatment, but the use of mesh requires further careful consideration.

The uncommon preoperative diagnosis of a De Garengeot hernia and its more novel laparoscopic treatment

This case report involves an elderly woman who presented with a 3-day history of a tender groin swelling on her right side. Her admission bloods were fairly unremarkable, but a preoperative ultrasound impressively confirmed a femoral hernia containing the appendix (De Garengeot hernia) and she underwent emergency laparoscopic hernioplasty with a prosthetic mesh and appendicectomy. The procedure found an incarcerated hernia with a strangulated tip of the appendix that unexpectedly separated upon gentle manipulation and histopathology revealed appendiceal inflammation. There were no complications with the patient's recovery and she was discharged 2 days after surgery.

De Garengeot Hernia, an acute appendicitis in the right femoral hernia canal, and successful management with transabdominal closure and appendectomy: a case Report

Incarceration of the appendix within a femoral hernia is a rare condition of abdominal wall hernia about 0.1 to 0.5% in reported femoral hernia [1]. We report a case of a 56-year-old female whose appendix was trapped in the right femoral canal. There are few reports in the literature on entrapment of the appendix within a femoral hernia. The management of this condition includes antibiotics, drainage appendectomy, hernioplasty and mesh repair.

Construction and validation of a predictive model for the risk of bowel resection in adults with incarcerated groin hernia

BACKGROUND

It is difficult to definitively determine the degree of ischemia in the bowel in which an incarcerated groin hernia is embedded. Failure to diagnose and intervene promptly and accurately increases the rate of bowel resection and patient mortality. The aim of this study is to investigate the risk factors for incarcerated inguinal hernia complicating bowel necrosis with resection and to establish a predictive model as a reference for clinical work.

METHODS

Patients with incarcerated groin hernia who were admitted to our hospital were retrospectively analyzed. They were divided into bowel resection and non-bowel resection groups based on whether bowel resection was performed in the surgical record and postoperative pathological results. Risk factors for the development of bowel resection in incarcerated groin hernia were analyzed by univariate analysis and multivariate logistic regression, respectively. The screened independent risk factors were used to establish a prediction model, and finally, the predictive ability and accuracy of the model were validated and the clinical benefit was analyzed.

RESULTS

A total of 345 patients with incarcerated groin hernia were included, of whom 58 underwent bowel resection for bowel necrosis and 287 did not. Multifactorial logistic regression analysis identified bowel obstruction (OR, 7.285 [95% CI, 2.254-23.542], P = 0.001), peritonitis (OR, 16.786 [95% CI, 5.436-51.838], P = 0.000), duration of incarcerated groin hernia (OR, 1.009 [95% CI, 1. 001-1.018], P = 0.034), heart rate (OR, 1.109 [95% CI, 1.021-1.205], P = 0.014), and preoperative total protein (OR, 0.900 [95% CI, 0.836-0.969], P = 0.005) were independent risk factors for bowel resection in incarcerated groin hernia. The predictive value of the established prediction model was basically in agreement with the measured value with a consistency index of 0.938 (0.901-0.974) and had a good clinical benefit.

CONCLUSION

Clinical screening and management of independent risk factors for bowel resection in patients with incarcerated groin hernia should be strengthened. The predictive model developed in this study has high diagnostic efficacy for bowel resection associated with incarcerated inguinal hernia, with the aim of reducing the incidence of bowel resection and unplanned secondary surgery.

The de Garengeot hernia chicken-and-egg conundrum: Acute appendicitis in an incarcerated femoral hernia, but which came first? A case report

INTRODUCTION

De Garengeot hernia is exceedingly rare and denotes a femoral hernia containing the appendix, which may or may not be inflamed. Given its low incidence, there is no clear consensus on the ideal surgical management of a de Garengeot hernia.

PRESENTATION OF CASE

This is a case report of an 81-year-old man who was admitted and operated on for a strangulated femoral hernia containing an inflamed appendix. Appendicectomy and primary hernia repair were performed in tandem using a single incision.

DISCUSSION

The case presented here provides a unique account of a subacute presentation of a de Garengeot hernia. It draws into question the true pathogenesis of appendicitis in this clinical setting, by lending credence to the theory that appendicitis can arise sporadically within a long-standing de Garengeot hernia, given the subacute-on-chronic nature of the patient's presentation. Furthermore, the case presented herein represents the minority of cases in which the diagnosis is clinched preoperatively based on computer tomography imaging as, in the vast majority of cases, definitive diagnosis is not made until the time of operation.

CONCLUSION

Due to the lack of prospective studies and randomised controlled trials, a standardised, evidence-based approach for the optimal surgical management of de Garengeot hernias remains elusive. Early recognition and diagnosis as well as an individualised approach that considers the patient's anatomy and clinical status are crucial to the management of De Garengeot hernias.

Femoral Hernia Containing a Strangulated Appendix: A Hybrid Approach

We present an intriguing case of an incarcerated femoral hernia containing an inflamed appendix inside the sac, also known as a De Garengeot hernia. This type of hernia is a rare occurrence that was first described in 1731 by the French surgeon René-Jacque Croissant de Garengeot. A 64-year-old woman presented to the emergency department with a painful mass in the right groin region. Following a computed tomography (CT) scan of the abdomen and pelvis to evaluate the mass, the diagnosis of a femoral hernia containing a strangulated appendix was established. Subsequently, a hybrid surgical approach was utilized, consisting of an open hernia repair and a laparoscopic appendectomy.

A case report of a combined laparoscopic and open approach for a De Garengeot hernia

INTRODUCTION

A De Garengeot hernia is defined as a femoral hernia containing the appendix. They are rare, representing 0.5-5 % of all femoral hernias.

PRESENTATION OF CASE

A sixty-five-year-old lady presented to the emergency department with a five-day history of right sided groin swelling and pain. She was an active smoker. Her workup included a computed tomography scan of her abdomen and pelvis which revealed a right sided femoral hernia containing the appendix. A laparoscopic appendicectomy and an open repair of femoral hernia with a mesh plug was performed. Intraoperatively, the distal appendix was seen to be incarcerated within the hernia sac. The histopathology confirmed acute appendicitis.

DISCUSSION

The increasing use of computed tomography scanning allows preoperative diagnosis of De Garengeot hernia. There is no standardized method for managing a De Garengeot hernia. The surgical technique used should be the one with which the surgeon is most comfortable. The decision to use a mesh to repair the hernia defect is based on the level of contamination in the field.

CONCLUSION

De Garengeot hernias are rare. They should be treated with appendicectomy and repair of the femoral hernia, at present there is no standardized approach and the surgeon should perform the method with which they are most comfortable.

De Garengeot’s hernia: case report

Introduction: De Garengeot hernia is an entity mainly diagnosed intraoperatively. It is more frequently observed in women and is defined as the presence of the vermiform appendix inside to femoral hernia. Most femoral hernias are identified based on clinical diagnosis, but diagnostic imaging is necessary for confirmation. Ultrasound, for example, is a valuable tool to characterize the anatomy of the hernia and its content, and to establish surgical planning. Case presentation: A 75-year-old woman attended the general surgery department of a high complexity hospital in Bogotá, Colombia, due to a painful mass in the right inguinal region. The initial ultrasound study showed a femoral hernia containing the incarcerated appendix and periappendiceal fluid in the hernial sac. The patient developed chronic appendiceal inflammation, so she underwent femoral hernia repair with mesh and appendectomy without complications, achieving a satisfactory recovery. Conclusion: Clinical examination may be sufficient to confirm the presence of a hernia in a large number of cases when the diagnostic approach involves the search of inguinal masses with pain. However, to facilitate surgical planning, diagnostic imaging, especially ultrasound with high resolution transducers, is the primary tool to characterize the type of hernia and the contents of the hernial sac.

De Garengeot Hernia: A Total Extraperitoneal Approach to a Femoral Hernia Repair

Introduction:

A de Garengeot’s hernia is a femoral hernia containing the appendix and accounts for approximately 0.8% of all femoral hernias.

Presentation of the Case:

This paper describes a case of an 84-year-old female who presented with abdominal pain, believed to have an incarcerated femoral hernia. Patient underwent a hernia repair and was found to have a femoral hernia involving the appendix, a de Garengeot’s hernia. The femoral hernia was repaired using a total extraperitoneal (TEP) approach.

Discussion:

There are a variety of reported ways to repair a de Garengeot hernia. In this case, we discuss the successful use of the TEP approach to repairing a de Garengeot hernia.

Conclusion:

Although rare, a de Garengeot hernia must remain on the differential when evaluating a patient for an incarcerated femoral hernia. A TEP approach provides the surgeon the ability to perform a variety of hernia repairs, regardless of what is encountered during the operation.

De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases

De Garengeot hernia is a rare femoral hernia that contains the vermiform appendix. It has always been a subject of interest, mainly because of its uncommon entity, but also because of the diagnostic challenge it presents and the lack of consensus in its surgical management. It mainly presents as an emergency, with strangulation of the femoral hernia and acute inflammation of the appendix. The purpose of this study is to present two cases of De Garengeot hernias, the different surgical approach in each one and to perform a systematic literature review on all published accounts of De Garengeot hernias focusing on the surgical management of the hernias that contained an inflamed appendix. A literature search was performed using the keywords 'De Garengeot hernia' and 'appendicitis in femoral hernia'. All the published papers in the English language from 1898 to the end of 2019, as well as two patients from Lewisham and Greenwich NHS Trust, were included. There were 110 female vs 17 males. The majority of the described approaches were via either a Lockwood, or a transinguinal (Lothestein/McVay) incision. Most of the operations were done with an open incision. In the presence of an inflamed appendix, most hernias were repaired with sutures. Forty-one patients had their hernia repaired with non-absorbable sutures and four with absorbable. Most of the patients recovered without complications and were discharged after an average of 4.82 days.

Appendix-preserving elective herniorrhaphy for de Garengeot hernia: two case reports

BACKGROUND

Emergency appendectomy is often performed for de Garengeot hernia. However, in some cases, there may be a chance to perform an appendix-preserving elective surgery.

CASE DESCRIPTION

A 76-year-old woman presented to our hospital with complaints of a right inguinal swelling, which we diagnosed as a de Garengeot hernia using computed tomography (CT). B-mode ultrasonography (US) of the mass showed an appendix 4-6 mm in diameter with a clear wall structure; color Doppler US showed pulsatile blood flow signal in the appendiceal wall. Twenty-eight days later, herniorrhaphy with transabdominal preperitoneal repair (TAPP) was performed without appendectomy. Another 70-year-old woman presented to our hospital with complaints of a painful bulge in the right inguinal region. The diagnosis of de Garengeot hernia was made using CT. B-mode US showed an appendix 5 mm in diameter with a clear wall structure. Color Doppler US showed a pulsatile blood signal in the appendiceal wall. Seven days later, herniorrhaphy with TAPP was performed without appendectomy.

CONCLUSION

De Garengeot hernia is often associated with appendicitis; however, an appendix-preserving elective herniorrhaphy can be performed if US and intraoperative findings do not suggest appendicitis or circulatory compromise in the appendix.

De Garengeot hernia doubly complicated: A case report

Introduction

A strangulated De Garengeot's hernia with appendicitis is an extremely rare surgical presentation. Therefore, the diagnosis is challenging, and there are no recommendations regarding a specific surgical approach.

Presentation of case

We present the case of a 56-year-old woman with a De Garengeot's hernia doubly complicated: strangulated and with appendicitis in the hernia sac. The diagnosis was made intraoperatively, and it was managed fully through a single inguinal incision. No postoperative complication was presented, and the patient was discharged 48 h after.

Discussion

The clinical presentation of this sub-type of hernia is non-specific. Precise knowledge of the hernia sac content preoperatively is not mandatory, and it should not delay prompt emergency surgery. As long as there are no local signs of complicated appendicitis, a single inguinal incision may be sufficient to perform appendectomy and hernia repair. In the event of complicated appendicitis, an exploratory of the abdominal cavity is mandatory, and hybrid approaches are recommended. For an experienced surgeon, the laparoscopic approach (TAPP), including the treatment of the two pathologies and the exploration of the peritoneal cavity, represents the surgical technique of choice.

Conclusion

De Garengeot's strangulated hernia with appendicitis is an exceedingly rare double surgical emergency. When uncomplicated appendicitis, a single inguinal incision is sufficient to treat both appendicitis and abdominal wall defect. Hernia reduction, which young surgeons in the emergency room commonly attempt, should be abolished.

•

A strangulated De Garengeot's hernia is a very rare pathology that requires an emergency surgery.

•

An abdominal CT scan is useful in case of strangulated hernia especially when associated to infection or peritonism signs.

•

Hernia Reduction, which is commonly attempted by young surgeons in the emergency room, should be abolished.

•

No clear consensus about the appropriate surgical management is available.

Minimally invasive management of de Garengeot hernia with staged robotic hernia repair

De Garengeot hernia is a rare phenomenon describing the migration of the appendix into a femoral hernia sac. Many repair strategies have been described although an open inguinal approach with suture repair is the most common technique. Despite strong evidence that mesh limits recurrence, most forgo mesh use in the presence of appendicitis for fear of contamination. We report a case in a 68-year-old man managed completely with minimally invasive strategies. We performed a staged laparoscopic appendectomy followed by robotic hernia repair with polypropylene mesh. This is the first described two-stage minimally invasive approach and the first report demonstrating the feasibility of robotic hernia repair in the setting of de Garengeot hernia. It is our opinion that using a staged approach may encourage mesh repair by minimising the risk of implant contamination. Furthermore, we believe a fully minimally invasive technique may result in improved outcomes.

Unusual case of De Garengeot hernia: femoral hernia containing purulent appendicitis in a 69-year-old man

A De Garengeot hernia is a rare type of femoral hernia that involves a vermiform appendix within a femoral hernia sac. Because of the rarity of this disease, a standard surgical procedure has not been established, and most cases are diagnosed intraoperatively. Preoperative diagnosis of a De Garengeot hernia is quite difficult. Computed tomography is the most sensitive and specific technique among the available imaging tests for preoperative diagnosis of a De Garengeot hernia. Although a standard surgical procedure is lacking, prompt surgery has become the consensus. The most common procedure is the open anterior approach; this allows exploration of the hernia sac and rapid treatment of its contents, routine appendectomy through a single incision, and preperitoneal repair of the femoral hernia.

Rare presentation of De Garengeot hernia treated by transabdominal preperitoneal hernia repair: A case report

We present a rare case of De Garengeot hernia treated with simultaneous laparoscopic appendectomy and transabdominal preperitoneal hernia repair. Our patient was an 85-year-old man with a bulging mass in the right groin. De Garengeot hernia was observed on contrast-enhanced CT. Urgent laparoscopy showed the distal part of the appendix passing through a right-sided femoral hernia. Laparoscopic appendectomy was performed, followed by transabdominal preperitoneal repair of the femoral hernia. Pathological examination revealed ischemic necrosis of the appendix. The patient's postoperative recovery was uneventful.

De Garengeot's Hernia Treated With a Hybrid Approach: A Case Report

De Garengeot's hernia happens when an inflamed or ischemic appendix is located within an incarcerated femoral hernia. We hereby report a case of De Garengeot's hernia treated with a combined open and laparoscopic approach. An 80-year-old male presented to the emergency department with a 1-day history of a tender right inguinal mass. A computed tomography scan revealed a direct right inguinal hernia containing an incarcerated appendix. At surgery, the diagnosis of a strangulated appendix within a femoral hernia was made. To avoid a wide disruption of the right groin region, the ischemic appendix was reduced into the abdomen and removed laparoscopically. The femoral defect was treated by open plug repair. De Garengeot's hernia may represent a surgical challenge. A combined open and laparoscopic approach is a good option in these cases.

De Garengeot hernia: a rare case in an elderly woman and a review of operative approaches

De Garengeot hernia is a rare finding of the vermiform appendix inside a femoral hernia sac. We report this occurrence in a 73-year-old woman who presented in the acute setting. There are no standardised surgical approaches and many different techniques have been described in case reports in the literature. We conducted a literature review of and found a total of 113 cases with addition of our case 114 unique cases were included for analysis. Inguinal incision was most cited (n=89). Concomitant laparotomy was needed in 13 patients, however, the association between type of incision and additional laparotomy was not significant (p>0.05). Laparoscopic surgery alone was performed in eight patients. Nine patients had hybrid surgery. The most common hernia repair was through suture technique with non-absorbable material (n=31). Mesh repair was used in 28 cases. More laparoscopic surgeries were done when the disease was diagnosed preoperatively (7/39, p<0.05).

An unusual reason for an inguinal swelling: De Garengeot's hernia

We present the case of a 71-year-old female with an inguinal swelling. Intra-abdominally the appendix was found in a femoral hernia sac (De Garengeot’s hernia). A laparoscopic transabdominal preperitoneal hernia repair procedure was performed with uneventful post-operative course.

Clinical presentation of this type of hernia is unspecific and often not to be distinguished from a common incarcerated hernia. Computed tomography can be helpful in obtaining a diagnosis, although the definite diagnosis is mostly found intraoperatively. As surgical options are numerous, there is no consensus on the most suitable one. A laparoscopic approach incorporates the benefit of a total abdominal overview and the possibility of standard procedures. If the appendix appears normal, the use of synthetic mesh is considered safe and an incidental appendectomy is not necessarily required.

Femoral hernia with vermiform appendix herniation: a case report and review of the literature

Femoral hernias constitute 2–4% of all groin hernia repairs. Herniation of the vermiform appendix into the femoral hernia sac is rare. The majority of patients with appendix hernias are asymptomatic and diagnosis is made intraoperatively. We report about a case of a female patient presenting with an irreducible right-sided femoral hernia without symptoms.

Revisiting Amyand's Hernia: A 20-Year Systematic Review

PURPOSE

Protrusion of the appendix within an inguinal hernia is termed an Amyand's hernia. A systematic review of case reports and case series of Amyand's hernia was performed, with emphasis on surgical decision-making.

METHODS

The English literature (2000-2019) was reviewed, using PubMed and Embase, combining the terms "hernia", "inguinal", "appendix", "appendicitis" and "Amyand". Overall, 231 studies were included, describing 442 patients.

RESULTS

Mean age of patients was 34 ± 32 years (adults 57.5%, children 42.5%). 91% were males, while a left-sided Amyand's hernia was observed in 9.5%. Of 156 elective hernia repairs, 38.5% underwent appendectomy and 61.5% simple reduction of the appendix. 88% of the adult patients had a mesh repair, without complications. Of 281 acute cases, hernial complications (76%) and acute appendicitis (12%) were the most common preoperative surgical indications. Appendectomy was performed in 79%, more extensive operations in 8% and simple reduction in 13% of cases. A mesh was used in 19% of adult patients following any type of resection and in 81% following reduction of the appendix. Among acute cases, mortality was 1.8% and morbidity 9.2%. Surgical site infections were observed in 3.6%, all of which in patients without mesh implantation.

CONCLUSION

In elective Amyand's hernia cases, appendectomy may be considered in certain patients, provided faecal spillage is avoided, to prevent mesh infection. In cases of appendicitis, prosthetic mesh may be used, if the surgical field is relatively clean, whereas endogenous tissue repairs are preferred in cases of heavy contamination.

De Garengeot hernia: a systematic review

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.

Successful one-stage laparoscopic procedure for de Garengeot hernia: a totally extraperitoneal repair-first approach

The de Garengeot hernia is a femoral hernia in which the appendix migrates into the hernia sac. It is usually diagnosed intraoperatively due to its rarity and lack of clinical presentation typical to acute appendicitis. Although most cases need emergency operation due to incarceration, no standard procedure exists. We report the case of a 49-year-old woman who was diagnosed with a de Garangeot hernia preoperatively by contrast-enhanced computed tomography. She underwent one-stage laparoscopic surgery via a totally extraperitoneal approach followed by laparoscopic appendectomy. She recovered uneventfully and was discharged on postoperative Day 3. Generally, hernioplasty and appendectomy are required for the de Garengeot hernia treatment. Avoiding a peritoneal incision around the herniation and performing a mesh repair prior to appendectomy is expected to carry a lower infectious risk than other laparoscopic procedures. With accurate diagnosis, this procedure could be a useful modality for de Garengeot hernia.

Clinicopathological characteristics of De Garengeot hernia: six case reports and literature review

BACKGROUND

De Garengeot hernia, wherein the appendix is present within a femoral hernia, is a rare disease; therefore, the clinicopathological features remain to be clarified. This study aimed to reveal the clinicopathological characteristics of De Garengeot hernia.

CASE PRESENTATION

Six patients who underwent appendectomy and herniorrhaphy between 1999 and 2018 were included. The incidence of De Garengeot hernia was 3.2% among the 182 femoral hernias that required surgery during the study period. The median age of the patients was 78 years, and five patients were women. The median body mass index was 20.1. Patients frequently had fever or elevated CRP level. Preoperative diagnoses based on computed tomography were femoral (n = 3), inguinal (n = 2), and De Garengeot (n = 1) hernias. Emergency and elective surgeries were performed in four and two patients, respectively. Histopathological examination of the resected appendix showed gangrenous appendicitis (n = 3), perforated appendicitis (n = 2), and appendiceal ischemia (n = 1) in the patients. Postoperatively, one patient developed sepsis.

CONCLUSIONS

Preoperative diagnosis of De Garengeot hernia is often difficult, and patients frequently have severe appendicitis. Precise diagnosis is required, and emergency surgery should be considered depending on the severity of appendicitis.

Symptomatic lump during lockdown - A case of de Garengeot's hernia

•

De Garengeot’s hernia is rare and describes a femoral hernia.

•

Imaging revealed typical radiological features of an inflamed appendix herniating through.

•

Femoral hernia contains the appendix was first described in 1731 by the Parisian surgeon Rene Jacques Croissant de Garengeot.

•

Femoral defect was repaired by approximation of the inguinal ligament and cooper ligament with 1.0 Ethibond on a J shaped needle.

Introduction

De Garengeot’s hernia is rare and describes a femoral hernia containing the vermiform appendix. Pre-operative diagnosis is at times difficult and operative intervention can prove challenging.

Presentation of case

We report a case of a 75-year-old woman with a swelling to the right groin for over 10 years which increased in size and became intermittently painful over a period of two weeks. Patient stated that an earlier consult was not sought as she had concerns about having to stay in hospital with the ongoing global pandemic and her significant cardiac history. Ultrasound and contrast enhanced Computed Tomography (CT) revealed typical radiological features of an inflamed appendix herniating through the femoral canal.

Discussion

Due to its rarity a preoperative diagnosis of a de Garengeot hernia may be difficult. There is currently no consensus to surgical approach in this setting, management is widely varied and based on the preference and expertise available during these emergency procedures.

Conclusion

The de Garengeot hernia though uncommon should be recognised as a differential when faced with an incarcerated femoral hernia. To the best of our knowledge, this is the first case that combines ultrasound, CT findings and a preperitoneal surgical intervention.

Lower urinary tract symptoms-Benign prostatic hyperplasia may increase the risk of subsequent inguinal hernia in a Taiwanese population: A nationwide population-Based cohort study

Introduction & objectives

It has been suggested that lower urinary tract symptoms—benign prostatic hyperplasia (LUTS-BPH) may be a risk factor for inguinal hernia (IH). The aim of this study was to examine the emergence of a subsequent IH diagnosis in men with and without LUTS-BPH.

Methods

From a database derived from the National Health Insurance Program covering 99% of the population in Taiwan, 22,310 men with LUTS-BPH and 22,310 matched men without LUTS-BPH were identified and followed for IH from 1997 to 2013. Both IH and LUTS-BPH were defined by the ninth revision of the International Classification of Diseases code (ICD9). Subjects younger than 20 years of age and with IH diagnosed before the index date were excluded. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) for subsequent IH, controlling for potential confounders.

Results

Men with and without LUTS-BPH had similar age and comorbidity distributions. During the 10 years of follow-up, 1,303 (5.84%) men with LUTS-BPH and 735 (2.53%) men without LUTS-BPH developed IH. The mean time to IH was 4.02 years and 4.44 years, respectively. After adjusting for age and comorbidities, LUTS-BPH was associated with a two-fold increased risk of IH (HR:2.25, 95% CI = 2.04–2.49).

Conclusion

This nation-wide population-based cohort study showed that LUTS-BPH increased the risk of subsequent IH in a Taiwanese Population.

De Garengeot's hernia: Case report and literature review

INTRODUCTION

De Garengeot's Hernia is a rare type of femoral hernia in which the appendix is located inside the herniated sac. Diagnosis of the condition is challenging and its treatment must be performed without delay.

PRESENTATION OF CASE

We present the case of a 75-year-old patient with a femoral hernia in which an appendix with signs of inflammation was found. An appendectomy followed by hernia repair was performed under an open preperitoneal approach according to Nyhus technique. The patient did not present any complications and was discharged on the second postoperative day.

DISCUSSION

This type of hernia is often unexpected and its preoperative diagnosis is difficult to perform. In most cases the clinical picture is indistinguishable from a common incarcerated hernia. Contrast-enhanced CT is the most useful complementary test, although it is not as accurate as desirable, so the diagnosis is frequently found intraoperatively. There is a wide variety of surgical options and there is no consensus on the most appropriate one. The preperitoneal approach enables the performance of an appendectomy and subsequent hernia reparation. The use of prosthesis should be considered if there are no signs of perforation or abscess.

CONCLUSION

De Garengeot's hernia is a very rare entity. The diagnosis and subsequent surgical treatment must be early to prevent the disease progression. The preperitoneal approach should be considered as the first choice technique, as it allows the exploration of the herniated sac and the performance of surgical procedures on its content.