De Garengeot Hernia: Case Report and Review of the Literature of a Rare Femoral Hernia

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.

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.

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

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

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

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No clear consensus about the appropriate surgical management is available.