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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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Zainudin S, Hayati F, Arumugam T, Ho KY. De Garengeot hernia: a rare case in an elderly woman and a review of operative approaches. BMJ Case Rep 2021; 14:14/4/e240557. [PMID: 33863769 PMCID: PMC8055123 DOI: 10.1136/bcr-2020-240557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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).
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Affiliation(s)
- Syaza Zainudin
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia .,Department of Surgery, Duchess of Kent Hospital, Sandakan, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | | | - Kah Yee Ho
- Department of Surgery, Duchess of Kent Hospital, Sandakan, Malaysia
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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] [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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Rosley MF, Gu J, Russell A, Wullschleger M, Patel B. De Garengeot hernia: revisited. ANZ J Surg 2019; 90:E38-E39. [PMID: 31069913 DOI: 10.1111/ans.15176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Muhammad F Rosley
- Acute Care Surgical Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Jennie Gu
- Acute Care Surgical Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Amelia Russell
- Acute Care Surgical Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Martin Wullschleger
- Acute Care Surgical Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Bhavik Patel
- Acute Care Surgical Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Filippou NG, Fanidou D, Alvanos G, Papadopoulos GO, Filippou D, Skandalakis P. Α very rare case of De Garengeot's hernia: Acute appendicitis within a femoral hernia. Clin Case Rep 2019; 7:87-89. [PMID: 30656015 PMCID: PMC6333059 DOI: 10.1002/ccr3.1914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022] Open
Abstract
De Garengeot's hernia is a rare clinical entity. Appropriate and acute diagnosis in emergency basis is challenging (usually misdiagnosed as incarcerated femoral hernia), and the surgical management varies from case to case. This report emphasizes the importance of including De Garengeot's hernia in the differential diagnosis of incarcerated groin hernias and the need to establish a well-defined strategy regarding surgical management options.
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Affiliation(s)
- Nikolaos G. Filippou
- 2 Surgical DepartmentAthens General Hospital “G. Gennimatas’’AthensGreece
- Department of Anatomy and Surgical Anatomy, Medical SchoolNational and Kapodestrian University of AthensAthensGreece
| | - Domna Fanidou
- 2 Surgical DepartmentAthens General Hospital “G. Gennimatas’’AthensGreece
- Department of Anatomy and Surgical Anatomy, Medical SchoolNational and Kapodestrian University of AthensAthensGreece
| | - Georgios Alvanos
- 2 Surgical DepartmentAthens General Hospital “G. Gennimatas’’AthensGreece
| | - Georgios Ouilson Papadopoulos
- Department of Anatomy and Surgical Anatomy, Medical SchoolNational and Kapodestrian University of AthensAthensGreece
- Department of Plastic SurgeryAthens General Hospital “Evangelismos”AthensGreece
| | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical SchoolNational and Kapodestrian University of AthensAthensGreece
| | - Panagiotis Skandalakis
- Department of Anatomy and Surgical Anatomy, Medical SchoolNational and Kapodestrian University of AthensAthensGreece
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Fisher MT, Adiletta A, Farrell TJ. Intra-operative identification of a De Garengeot hernia: a rare finding and discussion of operative approach. J Surg Case Rep 2018; 2018:rjy186. [PMID: 30151100 PMCID: PMC6101550 DOI: 10.1093/jscr/rjy186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/07/2018] [Indexed: 11/25/2022] Open
Abstract
The presence of an incarcerated vermiform appendix within a femoral hernia defect, a De Garengeot hernia, is distinctly different than an inguinal hernia containing the appendix, an Amyand hernia. The De Garengeot hernia is a rare finding with few reported cases. We present a 35-year-old female with a painful groin mass palpable below the inguinal ligament. An ultrasound of the groin revealed a thin-walled fluid collection medial to the femoral vessels. No additional imaging at the time was obtained. Intra-operatively, the patient was found to have her distal appendix incarcerated within the transected hernia sac thus altering the planned surgical procedure. We present a unique operative approach for managing a De Garengeot hernia.
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Affiliation(s)
- Matthew T Fisher
- General Surgery, Geisinger Wyoming Valley Hospital, Wilkes-Barre, PA, USA
| | - Antonio Adiletta
- Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Timothy J Farrell
- General Surgery, Geisinger Community Medical Center, Scranton, PA, USA
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Misiakos EP, Paspala A, Prodromidou A, Machairas N, Domi V, Koliakos N, Karatzas T, Zavras N, Machairas A. De Garengeot's Hernia: Report of a Rare Surgical Emergency and Review of the Literature. Front Surg 2018; 5:12. [PMID: 29564329 PMCID: PMC5850853 DOI: 10.3389/fsurg.2018.00012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Evangelos P. Misiakos
- 3 Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anna Paspala
- 3 Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anastasia Prodromidou
- 2 Department of Propaedeutic Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Machairas
- 3 Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vasileia Domi
- 3 Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Koliakos
- 3 Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodore Karatzas
- 2 Department of Propaedeutic Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nick Zavras
- 3 Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anastasios Machairas
- 3 Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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