Diagnosis and operative management of a perforated de Garengeot hernia

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.

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).

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.

Case study: diagnosis and operative management of de Garengeot hernia without appendectomy during the COVID-19 pandemic

de Garengeot herniae have been reported in <100 cases in literature. They are characterized by an incarcerated femoral hernia containing the appendix. We present the case of a 45-year-old female who, upon emergency intraoperative consultation to a general surgeon while having a right groin exploration by a plastic surgeon, was found to have an appendix incarcerated within a femoral hernia. There was no evidence of appendicitis; thus, appendix was reduced and the hernia was repaired with a mesh plug. The patient did well postoperatively, with no complications and returned to complete activities. This occurred during the coronavirus disease (COVID-19) pandemic. Due to the common failure in preoperative diagnosis, it is important for surgeons to have a clinical suspicion for de Garengeot herniae for patients, presenting with a right groin bulge. Appendectomy may be safely avoided, eliminating appendectomy-associated morbidity and avoiding hospital transfer and the associated risk of COVID-19 exposure.

De Garengeot's Hernia: Report of a Rare Surgical Emergency and Review of the Literature

This is a report of a case who was admitted and operated on for a strangulated femoral hernia. The hernia sac contained a gangrenous appendix, which was excised and the hernia was repaired with sutures without complication. De Garengeot's hernia, although very rare, should be included in the differential diagnosis of cases with strangulated hernia and should receive the optimal treatment.