A rare presentation of appendicitis as groin swelling: a case report

Amyand's hernia: which oncologic risk can be hidden in the sac?

Amyand's hernia (AH) is a rare condition in which the appendix is found in the sac of an inguinal hernia. It occurs in only 1% of adult inguinal hernias. The herniated appendix can occasionally range varying degrees of acute inflammation up to neoplastic transformation. An appendiceal tumor can be rarely described inside the AH sac. We describe a case of gangrenous appendicitis in AH and offer a review of the literature on AH when presenting with appendicitis associated with appendiceal cancer. As of 2022, only nine cases of AH presenting with appendicitis associated with appendiceal cancer have been reported by the pertinent literature. In order of decreasing frequency, AH, AH-related appendicitis and AH-related appendicitis associated with appendiceal cancer are three rare conditions. Particular attention should be kept in each situation as diagnosis is achieved postoperatively most of the times.

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).

Treatment of de Garengeot's hernia: a meta-analysis

Purpose

de Garengeot’s hernia is a rare entity in which the appendix is located within a femoral hernia and is almost invariably encountered incarcerated in an emergency setting with concomitant appendicitis. In the literature, there are mostly single-case reports. The purpose of the present study was to perform a review of the literature to study the incidence, pathogenesis, demographics, clinical presentation, laboratory and radiological investigations, differential diagnosis, delay in diagnosis and treatment, operative findings, surgical technique, histological findings, the postoperative course, use of antibiotics, and complications regarding de Garengeot’s hernia.

Methods

A literature search was performed through PubMed with the following search terms, single or in combination: Garengeot, femoral hernia, and appendicitis. Additional references were also found within the articles, and two patients from Uppsala University Hospital were added.

Results

Between 1981 and 2016, 70 publications were identified, and with the additional two patients, the present series comprised 90 patients There were 75 women (median age 73.0 years) and 15 men (median age 78.0 years). On examination, an inguinal mass was found in 87 patients (97%), which was painful and the cause of primary complaint in 67 patients (74%): the median duration of symptoms was 3 days. Radiological investigations or ultrasound were performed in 67 patients (74%); computed tomography was the most accurate with a positive diagnosis in 23/34 patients. Appendicitis was found in 76 patients, gangrenous in 23, and perforated in 9. The surgical approach was inguinal in 76 patients, including 15 with concomitant laparotomy. The preperitoneal route was chosen in six patients, and laparoscopy alone in four patients. A mesh/plug was used in 22 patients (7/22 normal appendix) and suture repair in 59 (4/59 normal appendix: p < 0.01). Complications were analysed in 79 patients and occurred in 11%. There was no mortality.

Conclusions

de Garengeot’s hernia is rare, being indistinguishable from an incarcerated femoral hernia in general. A delay in surgery should be avoided but if needed, computed tomography may be used for differential diagnosis. Although there is no standard treatment, mesh material does not appear advisable in the presence of a perforation, and it is beneficial for the surgeons to perform their routine method rather than a specific technique.

Acute pyogenic inguinal abscess from complex soft-tissue infection or intra-abdominal pathology

BACKGROUND

Abscesses involving the inguinal region are uncommon as manifestations of complex soft-tissue infections or intra-abdominal pathology, and the routes by which they cause infection are usually unclear and may be overlooked.

METHODS

A comprehensive review of reports in the English language literature of the clinical presentations, outcomes, and causes of abscess in the inguinal/groin area requiring surgical intervention. The cases of 33 patients, including 30 patients in 27 reports in the literature and 3 patients in the Chang Gung Memorial Hospital at Chia-Yi, were reviewed to determine the ages, positions, gender, hypothesized causes, diagnostic modalities, and clinical outcomes of abscesses in the inguinal/groin area. Clinical data, laboratory examination findings, and culture results were analyzed.

RESULTS

Inguinal abscesses presented as tender inguinal masses that could extend from gastrointestinal, genitourinary, or retroperitoneal sites as well as being of miscellaneous origin. Most patients with such abscesses presented with fever and leukocytosis. Computed tomography provided a sensitive means for establishing the correct diagnosis and surgical plan of treatment for inguinal sbscesses. Gram-positive pathogens were associated with infections involving hip or thigh muscles and gram-negative pathogens were associated with infections involving the gastrointestinal (GI) and genitourinary (GU) tracts as well as with abscesses of the psoas muscle, Discussion: The inguinal region communicates through several routes with the peritoneal and retroperitoneal spaces as well as with the region of the thigh. The lymphatics drain from the external genitalia, inferior anal canal or perianal region, adjoining abdominal wall, and the lower extremities. Evaluation of a patient with inguinal abscess and with signs of infection should include computed tomography (CT) to elucidate the extent of infectious disease. Information obtained from CT is important in guiding the prescription of antibiotics and surgical planning for the treatment of inguinal abscesses.

CONCLUSIONS

Computed tomography is helpful in diagnosing inguinal abscess and determining the extent of infection. In patients presenting with inguinal abscess. Early recognition of its origin can facilitate further surgical planning and possibly improve the outcome.

Encysted hydrocele of cord in an adult misdiagnosed as irreducible hernia: a case report

A number of pathologies can present as groin swellings in adults.Among these, encysted hydrocele of the cord presenting as swelling in an adult is a rare. A case of encysted hydrocele of cord in 36 year old male mimicking as as an irreducible hernia is reported. The diagnosis of hydrocele was made intraoperatively. An excision of the sac was performed.

De Garengeot's hernia: a comprehensive review

PURPOSE

Acute appendicitis within a femoral hernia is a rare condition that was first described by Rene Jacques de Garengeot. In the present study, we summarize the existing evidence on de Garengeot's hernia, with special emphasis on its clinical presentation and diagnostic approach.

METHODS

A thorough search of the English-language literature published between 1980 and 2011 was performed. Studies reporting cases of de Garengeot's hernia were selected using specific inclusion criteria (description of femoral hernia appendicitis, statement of patient demographics and symptoms, and statement of diagnostic tests performed).

RESULTS

Thirty-one studies that encompassed 36 patients (28 women, mean age 71.5 years) with de Garengeot's hernia were included in our analysis. Patients presented with a right groin mass in 35 (97 %) cases. The mass was almost always painful (n = 35, 97 %), while 14 (39 %) of the patients were febrile. Mean duration of symptoms was 5.17 days. Fifty-six percent of the groin masses were erythematous. Leukocytosis was present in 67 % of the patients, and 25 patients underwent imaging investigation with X-ray (n = 11), Ultrasound (n = 5) or Computed Tomography (CT, n = 9). Twenty percent of the Ultrasound and 44 % of the CT studies were diagnostic, leading to an overall rate of 14 % of femoral hernia appendicitis preoperative diagnosis. Eighty-one percent of the patients underwent herniorrhaphy with sutures while a mesh was used in 19 %. Mean hospital stay was 6.23 days.

CONCLUSION

Preoperative diagnosis of de Garengeot's hernia is difficult due to its atypical clinical presentation. Further surgical treatment depends on the surgeon's sound clinical judgment.