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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yu PC, Wang LT, Chang CY, Tsai YC, Chong KH. De Garengeot Hernia, an acute appendicitis in the right femoral hernia canal, and successful management with transabdominal closure and appendectomy: a case Report. BMC Urol 2024; 24:41. [PMID: 38365727 PMCID: PMC10870586 DOI: 10.1186/s12894-023-01383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 11/27/2023] [Indexed: 02/18/2024] Open
Abstract
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.
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Affiliation(s)
- Po-Chuan Yu
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan
| | - Ling-Ting Wang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan
| | - Chun-Yu Chang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan
| | - Kian-Hwee Chong
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan.
- Department of Surgery, School of Medicine, Buddhist Tzu Chi University, Hualien, 97004, Taiwan.
- Department of General Surgery, Taipei Tzu Chi Hospital, No.289, Jianguo Rd., Xindian Dist, New Taipei, 231405, Taiwan.
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3
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Tryggvadottir RR, Moller PH, Vidarsdottir H. [ De Garengeot hernia - a case report]. LAEKNABLADID 2023; 109:560-562. [PMID: 38031981 DOI: 10.17992/lbl.2023.12.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
We report a case of a 79-year-old woman with a previous history of polycythemia vera, glaucoma and hypertension. Her previous surgeries included a cholecystectomy with an incidental finding of a gallbladder carcinoma with following partial liver resection and a hysterectomy. The surgery department was consulted regarding this patient due to abdominal pain in her lower abdomen and tumor in her right groin. A CT scan of the abdomen was obtained that showed a hernia with the appendix vermiformis in the hernia sac. She was operated with a preperitoneal open approach and an inflamed appendix from a femoral hernia sac was removed and a herniorrhaphy with a mesh was performed. The patient was discharged the day after the surgery. Femoral hernia with the appendix in the hernia sac is a rare type of hernia first descriped by Rene-Jacques De Garengeot in 1731 and now bearing his name.
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Affiliation(s)
| | - Pall Helgi Moller
- Department of Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Imataki H, Miyake H, Nagai H, Yoshioka Y, Shibata K, Kambara Y, Yuasa N. Appendix-preserving elective herniorrhaphy for de Garengeot hernia: two case reports. Surg Case Rep 2021; 7:246. [PMID: 34807319 PMCID: PMC8608983 DOI: 10.1186/s40792-021-01329-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Hiromitsu Imataki
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hidemasa Nagai
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Koji Shibata
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yuichi Kambara
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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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.
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Affiliation(s)
- Timothy M Guenther
- Department of Surgery, University of California Davis, 2335 Stockton Blvd, 5th floor, Sacramento, CA, 95817, USA.
- Department of Surgery, David Grant USAF Medical Center, 101 Bolin Circle, Travis AFB, Fairfield, CA, 95433, USA.
| | - Christina M Theodorou
- Department of Surgery, University of California Davis, 2335 Stockton Blvd, 5th floor, Sacramento, CA, 95817, USA
| | - Nalani L Grace
- Department of General Surgery, Sacramento VA Medical Center - VA Northern California Health Care System, CA, 10535 Hospital Way, Mather, 95655, USA
| | - Tanya N Rinderknecht
- Department of Surgery, University of California Davis, 2335 Stockton Blvd, 5th floor, Sacramento, CA, 95817, USA
| | - James E Wiedeman
- Department of General Surgery, Sacramento VA Medical Center - VA Northern California Health Care System, CA, 10535 Hospital Way, Mather, 95655, USA
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Tsuruta S, Miyake H, Nagai H, Yoshioka Y, Yuasa N, Fujino M. Clinicopathological characteristics of De Garengeot hernia: six case reports and literature review. Surg Case Rep 2021; 7:14. [PMID: 33427959 PMCID: PMC7801540 DOI: 10.1186/s40792-020-01098-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Shigeaki Tsuruta
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hidemasa Nagai
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Masahiko Fujino
- Department of Cytology and Molecular Pathology, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
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Bidarmaghz B, Borrowdale RC, Raufian K. A rare presentation of appendicitis inside the femoral canal: case report and literature review. Surg Case Rep 2018; 4:143. [PMID: 30547242 PMCID: PMC6292845 DOI: 10.1186/s40792-018-0552-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 11/21/2022] Open
Abstract
Background Femoral hernia accounts for 3% of all the hernias, and in 0.5–5% of cases, the appendix can migrate through the femoral hernia and is called de Garengeot hernia. It is a very rare condition, and the incidence of appendicitis in this type of hernia is as low as 0.08–0.13%. Case presentation We bring into discussion a case of a 47-year-old female who presented to the emergency department with a painful right-sided groin lump for the past 2 days. After initial resuscitation, a CT scan was requested which showed the presence of inflamed appendix inside the femoral canal. She was taken to the operative theatre, and during the laparoscopy, the appendix was identified migrating through the femoral canal and it could not be retracted into the peritoneal cavity; therefore, the mesoappendix was divided and the operation converted to the open low approach. After identifying the femoral hernia sac and opening it, the appendix was removed and herniorrhaphy was performed. Our patient had an uneventful recovery and was discharged on the following day. Conclusion We report a rare case of de Garengeot hernia which was diagnosed preoperatively. Because of its non-specific presentation, patients are usually diagnosed with incarcerated femoral hernia and are taken to operative theatre and the final diagnosis is made intra-operatively. Due to its rarity, there is no standard approach for this condition, and emergency appendicectomy and concurrent herniorrhaphy is the mainstay of treatment. In this paper, we present different surgical methods for the treatment of this type of hernia.
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Affiliation(s)
- Bardia Bidarmaghz
- Department of General surgery, Redcliffe Hospital, Redcliffe, QLD, 4020, Australia.
| | | | - Kasra Raufian
- Department of General surgery, Redcliffe Hospital, Redcliffe, QLD, 4020, Australia
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Klipfel A, Venkatasamy A, Nicolai C, Roedlich MN, Veillon F, Brigand C, Rohr S, Romain B. Surgical management of a De Garengeot's hernia using a biologic mesh: A case report and review of literature. Int J Surg Case Rep 2017; 39:273-275. [PMID: 28881337 PMCID: PMC5587892 DOI: 10.1016/j.ijscr.2017.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 11/24/2022] Open
Abstract
The De Garengeot hernia is a rare form of femoral hernia, containing the appendix, first described by french surgeon René Jacques Croissant de Garengeot (1688–1759). There is no consensus for the surgical approach in case of a De Garengeot hernia. In this case, we chose to perform an inguinal approach associated with a laparoscopic procedure. We chose to repair the femoral hernia with a biological mesh to prevent infections.
Introduction A De Garengeot hernia is a rare form of femoral hernia, where the appendix is found in the herniated sac. This feature is important to report, as both the diagnosis and the treatment are quite challenging in this particular condition. Presentation of case We report the case of a 77-year-old female presenting with a femoral hernia, containing an incarcerated necrotic vermiform appendix (De Garengeot hernia). A laparoscopic appendectomy was performed and the herniated defect was repaired according to Rives technique, using a biological mesh. Discussion The De Garengeot hernia is often unexpected and diagnosed intra-operatively. A pre-operative diagnosis is quite difficult, as it often presents clinically as a strangled femoral hernia. In patients without peritoneal signs, a contrast-enhanced Computed Tomography (CT) of the abdomen is useful for the diagnosis. Many surgical techniques have been discussed in literature, but there is no consensus. We show the feasibility and safety of the hernia repair according to Rives technique, through an inguinotomy with a biologic mesh. A laparoscopic approach was used to remove the necrotic appendix. Conclusion The De Garengeot hernia is an uncommon differential diagnosis for patients presenting with clinical signs of strangled femoral hernia. Although hernia repairs with a synthetic mesh in the presence of appendicitis have been reported, we describe a case of femoral hernia repair using a biologic mesh, in a patient with a De Garengot hernia.
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Affiliation(s)
- Amandine Klipfel
- Department of Digestive Surgery, Strasbourg University, 1 Avenue Moliere, 67000 Strasbourg, France
| | - Aïna Venkatasamy
- Department of Radiology 1, Strasbourg University, 1 Avenue Moliere, 67000 Strasbourg, France
| | - Caroline Nicolai
- Department of Radiology 1, Strasbourg University, 1 Avenue Moliere, 67000 Strasbourg, France
| | - Marie-Noëlle Roedlich
- Department of Radiology 1, Strasbourg University, 1 Avenue Moliere, 67000 Strasbourg, France
| | - Francis Veillon
- Department of Radiology 1, Strasbourg University, 1 Avenue Moliere, 67000 Strasbourg, France
| | - Cécile Brigand
- Department of Digestive Surgery, Strasbourg University, 1 Avenue Moliere, 67000 Strasbourg, France
| | - Serge Rohr
- Department of Digestive Surgery, Strasbourg University, 1 Avenue Moliere, 67000 Strasbourg, France
| | - Benoît Romain
- Department of Digestive Surgery, Strasbourg University, 1 Avenue Moliere, 67000 Strasbourg, France.
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Mashima H, Banshodani M, Nishihara M, Nambu J, Kawaguchi Y, Shimamoto F, Dohi K, Sugino K, Ohdan H. De Garengeot hernia with perforated appendicitis and a groin subcutaneous abscess: A case report. Int J Surg Case Rep 2017; 33:8-11. [PMID: 28262593 PMCID: PMC5334518 DOI: 10.1016/j.ijscr.2017.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 11/15/2022] Open
Abstract
De Garengeot hernia with a groin subcutaneous abscess is rare. Appendectomy and herniorrhaphy via the same incision may be more effective. Clinicians should consider de Garengeot hernia in patients with a groin hernia.
Introduction De Garengeot hernia is rare. Although previous reports have suggested various surgical options according to patient condition, comorbidities, surgeon preference, and clinical findings during surgery, a treatment strategy has not been established. Presentation of case An 81-year-old woman presented with an irreducible tender mass that was subsequently diagnosed as an incarcerated femoral hernia with a subcutaneous abscess in the right groin. Intraoperative findings revealed a necrotic and perforated appendix strangulated by the femoral ring for which an appendectomy and herniorrhaphy was performed concurrently through the hernia sac. The subcutaneous abscess cavity was washed thoroughly and a drainage tube was placed within it. The patient recovered uneventfully. Discussion We suggest that the approach through the inguinal incision in both appendectomy and herniorrhaphy with drainage may be useful in avoiding intra-abdominal contamination in cases of de Garengeot hernia with subcutaneous abscess. Conclusion Here, we described a case of de Garengeot hernia with a subcutaneous abscess in the groin. Clinicians should consider de Garengeot hernia in patients with a groin hernia, make an early diagnosis, and promptly provide surgical treatment to reduce the risk of complications.
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Affiliation(s)
- Hiroaki Mashima
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institution of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masataka Banshodani
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
| | - Masahiro Nishihara
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Junko Nambu
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Yasuo Kawaguchi
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Fumio Shimamoto
- Department of Pathology, Faculty of Humanities and Human Science, Hiroshima Shudo University, Hiroshima, Japan
| | - Kiyohiko Dohi
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Keizo Sugino
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institution of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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Abstract
A de Garengeot hernia is defined as an incarcerated femoral hernia containing the vermiform appendix. We describe the case of a patient with a type 4 appendiceal diverticulum within a de Garengeot hernia and delineate valuable learning points. A 76-year-old woman presented with a 2-week history of a non-reducible painless femoral mass. Outpatient ultrasonography demonstrated a 36mm × 20mm smooth walled, multiloculated, partially cystic lesion anterior to the right inguinal ligament in keeping with an incarcerated femoral hernia. Intraoperatively, the appendix was found to be incarcerated in the sac of the femoral hernia and appendicectomy was performed. Histopathology demonstrated no evidence of inflammation in the appendix. However, an incidental appendiceal diverticulum was identified. It is widely recognised that a de Garengeot hernia may present with concomitant appendicitis, secondary to raised intraluminal pressure in the incarcerated appendix. Appendiceal diverticulosis is also believed to develop in response to raised pressure in the appendix and may therefore develop secondary to incarceration in a de Garengeot hernia. To our knowledge, only one such case has been described in the literature. A de Garengeot hernia is a rare entity, which poses significant diagnostic challenges. A high index of clinical suspicion is necessary as these hernias are at particularly high risk of perforation and so prompt surgical management is paramount.
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Affiliation(s)
- S H Rossi
- West Suffolk NHS Foundation Trust , UK
| | - E Coveney
- West Suffolk NHS Foundation Trust , UK
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15
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Talini C, Oliveira LO, Araújo ACF, Netto FACS, Westphalen AP. De Garengeot hernia: Case report and review. Int J Surg Case Rep 2015; 8C:35-7. [PMID: 25622240 PMCID: PMC4353942 DOI: 10.1016/j.ijscr.2014.12.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/28/2014] [Indexed: 01/03/2023] Open
Abstract
We report a rare case of incarcerated femoral hernia containing the appendix inside the hernia sac (De Garengeot hernia) without appendicitis. The presence of the appendix within a femoral hernia sac is uncommon and is generally found only during surgery. Most times patient are taken to emergency surgery with the nonspecific diagnose of incarcerated hernia. The patient in this case was submitted to inguinotomy with appendectomy and hernia repair using mesh and presented good outcome, without complications or hernia recurrence.
Introduction Rene De Garengeot, a French surgeon, was the first to describe the presence of the appendix inside a femoral hernia sac in 1731. It is a rare entity that has fewer than 100 cases reported in literature. Presentation of case An 86 years-old male patient, comes to Emergency Department complaining of painful bulging in the right inguinal region, associated with local inflammatory signs. He was initially diagnosed as incarcerated femoral hernia and underwent emergency open surgery. Inguinotomy was performed and after hernia sac dissection it was possible to observe the presence of the appendix incarcerated in its interior, without clinical signs of appendicitis. Surgeons performed appendectomy and inguinal repair of the femoral hernia with placement of a polypropylene mesh. Discussion De Garengeot hernia is a rare entity that requires early treatment in order to avoid possible complications. When facing a patient with incarcerated hernia emergency surgery must be indicated even if it is not possible to determine the contents of the hernia. Conclusion This paper presents a case report of a De Garengeot hernia patient who presented a good evolution after surgery.
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Affiliation(s)
- Carolina Talini
- General Surgery Resident at Hospital Universitário do Oeste do Paraná, Av. Tancredo Neves, 3224, Zip Code 85806-470, Cascavel, PR, Brazil.
| | - Luan Ocaña Oliveira
- Medical Student at Universidade Estadual do Oeste do Paraná, Rua Universitária, 2069, Zip Code 85819-110, Cascavel, PR, Brazil.
| | - Allan César Faria Araújo
- Assistant Professor at Universidade Estadual do Oeste do Paraná, Rua Universitária, 2069, Zip Code 85819-110, Cascavel, PR, Brazil.
| | | | - André Pereira Westphalen
- Coordinator of General Surgery Residency and Assistant Professor at Hospital Universitário do Oeste do Paraná, Av. Tancredo Neves, 3224, Zip Code 85806-470, Cascavel, PR, Brazil.
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Abstract
Appendicitis in a femoral hernia is a rare occurrence often diagnosed intraoperatively. We present a case where the incarcerated appendicitis required division of the inguinal ligament for reduction. Appendectomy was carried out and because of contamination a primary McVay procedure was done to repair the femoral hernia. The patient tolerated the surgery and was discharged shortly.
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Affiliation(s)
- Jeffrey Shum
- Division of General Surgery, The University of Western Ontario, University Hospital C8-114, 339 Windermere Rd., London, ON, Canada N6A 5A5
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