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Iovino M, D’Elia AC, Rispo M, Rispo A, Brunetti A, Sandomenico F. A rare case of De Garengeot hernia: CT findings. BJR Case Rep 2024; 10:uaae009. [PMID: 38468719 PMCID: PMC10927328 DOI: 10.1093/bjrcr/uaae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
We report a case of "De Garengeot's hernia" (DGH), a rare condition that occurs when the inflamed appendix is localized inside a femoral hernia. The appendix may be involved in inflammatory or necrotic processes and the treatment is emergency surgery. It is usually discovered by chance during surgery. It occurs in 0.5%-5% of all femoral hernias. In 0.08%-0.13% of cases, the appendix can present inflammatory or necrotic processes due to the narrowness of the neck of the femoral canal; in these cases, an emergency surgery is required through a no standard surgical procedure. In the other cases, it is usually found accidentally during surgical repair of the hernia or more rarely diagnosed preoperatively by CT. Therefore, the purpose of our study is to report a case of DGH describing CT main findings in order to improve the preoperative diagnosis.
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Affiliation(s)
- Maria Iovino
- Radiology Unit, San Giuliano Hospital, Giugliano In Campania, Naples 80014, Italy
| | - Anna Chiara D’Elia
- Department of Diagnostic Imaging and Radiotherapy, University Federico II, Naples 80100, Italy
| | - Maurizio Rispo
- Radiology Unit, San Giuliano Hospital, Giugliano In Campania, Naples 80014, Italy
| | - Alfonso Rispo
- Surgery Unit, San Giuliano Hospital, Giugliano In Campania, Naples 80014, Italy
| | - Arturo Brunetti
- Department of Diagnostic Imaging and Radiotherapy, University Federico II, Naples 80100, Italy
| | - Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples 80123, Italy
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Nerabani Y, Hamdan O, Al-Kurdi MAM, Alkhaleel W, Ghazal A. Strangulated femoral hernia with appendicitis: A rare case of De Garengeot's hernia. Int J Surg Case Rep 2023; 106:108272. [PMID: 37167688 DOI: 10.1016/j.ijscr.2023.108272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE De Garengeot hernia is a rare case of a femoral hernia. It occurs when a femoral hernia contains a vermiform appendix that may be inflamed and sometimes necrotic, and this requires emergency surgery. However, the hernia is usually discovered by chance in the operating theater, which poses an additional challenge for surgeons. CASE PRESENTATION A 64-year-old man presented with a 1-week history of a painful right groin lump. The lump is irreducible and painful on exert a week ago. Ultrasound imaging showed a 1.5 × 2 cm loculated turbid liquid collection containing an edematous intestinal loop measuring 8 mm in diameter that was suspected to be the vermiform appendix. Therefore, appendectomy was performed through the hernia sac. After that, the hernia was repaired using the McVay technique and 2.0 nylon sutures. One day after the operation, the patient was discharged, and he returned to the clinic after 10 days without any complications. CLINICAL DISCUSSION The patient has a history of chronic obstructive pulmonary disease (COPD), which is a risk factor for a hernia. He had to live with the right femoral hernia for ten years until it became painful and irreversible. Ultrasound revealed what appears to be an appendix. To avoid possible consequences of complicated appendicitis and strangulated hernia, emergency surgery was the appropriate choice for our patient case. CONCLUSION The presence of an appendix in the femoral hernia poses a diagnostic and therapeutic challenge to surgeons, due to the atypical clinical picture and the lack of efficacy of radiographic methods in diagnosing the condition.
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Affiliation(s)
- Yaman Nerabani
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic.
| | - Ola Hamdan
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | | | - Wael Alkhaleel
- Department of Surgery, Aleppo University Hospital, Aleppo, Syrian Arab Republic
| | - Ahmad Ghazal
- Department of Surgery, Aleppo University Hospital, Aleppo, Syrian Arab Republic
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Shuttleworth P, Sabri S, Mihailescu A. The Utility of Minimally Invasive Surgery in the Emergency Management of Femoral Hernias: A Systematic Review. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11217. [PMID: 38312401 PMCID: PMC10831683 DOI: 10.3389/jaws.2023.11217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/10/2023] [Indexed: 02/06/2024]
Abstract
Background: Femoral hernias are a relatively rare type of hernia but have a high complication rate, with a high proportion either presenting as an emergency or requiring emergency management. Minimal access surgery has been shown to be safe, with good results, in an elective setting, but there is little published evidence of its utility in an emergency. Methods: A systematic review was conducted searching PubMed, OVID, Embase, and Cochrane reviews for ((Femoral hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). Results: 286 manuscripts were identified of which 33 were relevant. 24 were individual case reports, 3 case series, 4 cohort studies or case control series, and 2 high level reviews of National registers. Conclusion: Minimal access surgery can avoid an unnecessary laparotomy for the assessment of hernial contents, especially via a TAPP approach. Minimal access repair of femoral hernias as an emergency is feasible and can be done safely with results similar to open surgery but good quality evidence is lacking.
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Affiliation(s)
- Paul Shuttleworth
- Department of General Surgery, Tameside General Hospital, Tameside and Glossop Foundation Trust, Ashton-under Lyne, United Kingdom
| | | | - Andrei Mihailescu
- Department of General Surgery, Tameside General Hospital, Tameside and Glossop Foundation Trust, Ashton-under Lyne, United Kingdom
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McLaughlin JP, Muhammed AH. A case report of a combined laparoscopic and open approach for a De Garengeot hernia. Int J Surg Case Rep 2023; 104:107964. [PMID: 36889157 PMCID: PMC9993028 DOI: 10.1016/j.ijscr.2023.107964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/18/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023] Open
Abstract
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.
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Quinn KM, Huang KX, Jones RH, Cina RA. Hypoxic respiratory failure in acute appendicitis: A bronchoperitoneal fistula as the presenting symptom of appendicitis in the setting of pediatric COVID-19. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022; 79:102223. [PMID: 35223426 PMCID: PMC8860748 DOI: 10.1016/j.epsc.2022.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 12/05/2022] Open
Abstract
Symptomatic COVID-19 less frequently affects the pediatric population and is often associated with atypical presenting symptoms. Here we describe a nine-year-old patient who presented with acute hypoxic respiratory failure and was found to have perforated appendicitis, intra-abdominal abscess, and bronchoperitoneal fistula. The rapid progression of this pathology, complex critical care decision making, and ultimate surgical management has not been previously described. Documenting this patient's clinical course and effective treatments may serve to inform and guide the medical community and pediatric care providers as the world continues to combat the COVID-19 pandemic.
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Affiliation(s)
- Kristen M Quinn
- Department of Surgery, Medical University of South Carolina, USA
| | - Kevin X Huang
- Department of Surgery, Medical University of South Carolina, USA
| | - Richard H Jones
- Department of Radiology, Medical University of South Carolina Shawn Jenkins Children's Hospital, USA
| | - Robert A Cina
- Department of Pediatric Surgery, Medical University of South Carolina Shawn Jenkins Children's Hospital, USA
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Yao MQ, Yi BH, Yang Y, Weng XQ, Fan JX, Jiang YP. De Garengeot hernia with avascular necrosis of the appendix: A case report. World J Clin Cases 2021; 9:11355-11361. [PMID: 35071566 PMCID: PMC8717499 DOI: 10.12998/wjcc.v9.i36.11355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain. There are various types of incarcerated hernias, including incarcerated hernias of the appendix. These hernias are often complicated by appendiceal inflammation, necrosis, and suppuration, which affect the outcome of surgical repair. A De Garengeot hernia is a femoral hernia that contains the appendix. This type of hernia has a low incidence. When a De Garengeot hernia is clinically suspected, emergency surgical treatment should be performed as soon as possible.
CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier. Physical examination revealed a 4 cm × 2 cm palpable mass in the right groin. The mass was hard and could not be reduced due to tenderness. It did not descend into the scrotum. B-ultrasound revealed an incarcerated hernia. During surgery, the hernia was found to contain the appendix, which exhibited distal avascular necrosis. A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia. Laparoscopic reduction of the incarcerated hernia, appendectomy, and small-incision femoral hernia repair were performed in the emergency department, and cefuroxime was administered as anti-infection therapy for 2 d postoperatively. After treatment, the patient had no abdominal pain or infection and was discharged on postoperative day 4. He had no recurrence of the inguinal hernia after 16 months of follow-up.
CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose. Laparoscopy is useful for their diagnosis and treatment.
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Affiliation(s)
- Min-Quan Yao
- Departments of Gastrointestinal Surgery, Tongxiang First People’s Hospital, Jiaxing 314500, Zhejiang Province, China
| | - Bing-Hong Yi
- Departments of Gastrointestinal Surgery, Tongxiang First People’s Hospital, Jiaxing 314500, Zhejiang Province, China
| | - Yong Yang
- Departments of Gastrointestinal Surgery, Tongxiang First People’s Hospital, Jiaxing 314500, Zhejiang Province, China
| | - Xiao-Qi Weng
- Departments of Gastrointestinal Surgery, Tongxiang First People’s Hospital, Jiaxing 314500, Zhejiang Province, China
| | - Jin-Xing Fan
- Departments of Gastrointestinal Surgery, Tongxiang First People’s Hospital, Jiaxing 314500, Zhejiang Province, China
| | - Yu-Peng Jiang
- Departments of Gastrointestinal Surgery, Tongxiang First People’s Hospital, Jiaxing 314500, Zhejiang Province, China
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Mejri A, Omry A, Arfaoui K, Rchidi J. De Garengeot hernia doubly complicated: A case report. Int J Surg Case Rep 2021; 86:106264. [PMID: 34399238 PMCID: PMC8371186 DOI: 10.1016/j.ijscr.2021.106264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Atef Mejri
- Department of General Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ahmed Omry
- Department of General Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Khaoula Arfaoui
- Department of Acute Care Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Jasser Rchidi
- Department of Acute Care Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Chaudhry MA, Neduchelyn Y, Ivanovski I, Sarwar H. De Garengeot hernia masquerading as a painless groin lump: a case report. J Surg Case Rep 2021; 2021:rjab291. [PMID: 34257904 PMCID: PMC8272393 DOI: 10.1093/jscr/rjab291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
De Garengeot’s hernia is a rare subtype of femoral hernia in which the appendix is located within the herniated sac. These cases are important to report as both the diagnosis and treatment are quite challenging. We present a case of a 68-year-old gentleman with few months history of a lump in the right groin that gave him mild discomfort but no other symptoms. Initial investigations with an ultrasound did not prove to be helpful and so a plan was made to surgically explore the lump. The appendiceal tip was incarcerated within the hernial sac. The appendix was removed using an open inguinal incision with repair of the defect using a light weight partially absorbable mesh. It is important to consider the possibility of a De Garangeot’s Hernia as a differential diagnosis for patients presenting with a groin lump.
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Affiliation(s)
| | | | - Ivan Ivanovski
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - Hassan Sarwar
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
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