Appendicitis in De Garengeot Hernia: A Rare Presentation.

De Garengeot hernia, a rare clinical entity characterized by the presence of the appendix within a femoral hernia sac, is a challenging condition often requiring prompt surgical intervention. Fewer than 100 cases have been reported in the literature containing appendicitis in de Garengeot hernia. We present a case of a 40-year-old female with a preoperatively diagnosed De Garengeot hernia with appendicitis. The patient presented with a painful and irreducible right groin swelling, and imaging revealed a femoral hernia containing an inflamed appendix. Urgent surgical intervention was undertaken, involving right femoral hernia repair and appendectomy. The surgical procedure, utilizing the infra-inguinal approach, proceeded uneventfully, with the patient recovering well postoperatively. De Garengeot hernia is a rare clinical presentation with no established treatment guidelines. Surgical management typically involves hernia repair and appendectomy, with the choice of repair method dependent on intraoperative findings. The use of prosthetic mesh in contaminated fields remains controversial, with considerations for infection risk and patient outcomes. Early diagnosis and appropriate surgical intervention are essential in managing De Garengeot hernia to prevent complications and ensure favourable patient outcomes. This case underscores the importance of recognizing and effectively treating this uncommon surgical condition.

De Garengeot hernia: A unique presentation of femoral hernia with perforated appendicitis.

INTRODUCTION: De Garengeot hernia is a rare subset of femoral hernias containing the vermiform appendix. It is more common in females. The presenting symptoms are non-specific hence diagnosis is challenging and there is no consensus on treatment of it. PRESENTATION OF CASE: An 85-year-old male patient who had previously undergone herniorrhaphy presented with a four-day history of pain and swelling in the right groin region. On a contrast-enhanced computed tomography scan it revealed incarceration of the appendix within femoral hernia. It was managed with appendectomy and closure of the defect using non-absorbable suture. DISCUSSION: Diagnosis of De Garengeot hernias remains challenging due to their non-specific presentation and attenuated clinical symptoms, often leading to intraoperative identification. It is crucial for physicians to recognize this rare presentation of appendicitis and be familiar with the available surgical interventions. However, the literature does not establish a consensus regarding the preferred surgical approach. CONCLUSION: De Garengeot hernia remains an uncommon and challenging presentation of femoral hernia, particularly when complicated by appendiceal incarceration leading to acute appendicitis. Surgical management should be tailored to each patient's unique circumstances.

Strangulated Femoral Hernia Containing Perforated Appendicitis and Perforated Small Bowel (De Garengeot Hernia): A Case Report.

A femoral hernia containing the appendix within the sac is known as De Garengeot hernia. This condition is relatively rare but is important to recognize because it combines the complications of both femoral hernia and acute appendicitis, which are two distinct surgical emergencies. Clinical findings of a strangulated or incarcerated hernia may obscure signs of acute appendicitis. The presence of the inflamed appendix within the femoral hernia sac complicates the management of both conditions and requires careful surgical planning. We report a case of an 87-year-old female with De Garengeot hernia, complicated by perforated appendicitis and strangulated small bowel with perforation.

Laparoscopic surgery for De Garengeot's hernia in a man after inguinal hernia surgery with a mesh plug: a case report and review of literature.

BACKGROUND: De Garengeot's hernia is a rare case of a femoral hernia that contains the appendix. Here we report a case of De Garengeot's hernia that occurred in a male patient who had a history of inguinal hernia surgery using a mesh plug. There were no reports of De Garengeot's hernia with a history of surgery for inguinal hernia, and the surgical question was whether we could successfully treat a patient with minimally invasive laparoscopic surgery using a mesh. CASE PRESENTATION: This case involved 75-year-old man with a history of right indirect inguinal hernia surgery using a mesh plug without on-lay mesh, who presented with a 5-day history of a right groin lump. Abdominal CT revealed an incarcerated appendix within the right femoral hernia and fluid collection around the appendix. Laparoscopic surgery was initiated and the incarcerated appendix was released with traction. There was no contamination around the appendix or the femoral ring, the appendix was removed, and the femoral hernia was repaired using mesh. Laparoscopic surgery was useful in first evaluating the inflammatory status of the appendix. As it was determined that there was little inflammation around the appendix and femoral ring, it was possible to repair the hernia using mesh. CONCLUSIONS: De Garengeot's hernias are rare and there is currently no standardized approach. Even if it is a recurrent hernia in the groin, laparoscopic surgery can be useful for diagnosis and treatment, but the use of mesh requires further careful consideration.

A rare case of De Garengeot hernia: CT findings.

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.

De Garengeot Hernia, an acute appendicitis in the right femoral hernia canal, and successful management with transabdominal closure and appendectomy: a case Report.

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.

Appendix-sparing laparoscopic transabdominal preperitoneal hernioplasty for a De Garengeot's hernia. A new case report and review of the literature.

Introduction and importance: More than 600 cases of De Garengeot's hernia, characterized by a femoral hernia containing the vermiform appendix, have been reported. The surgical method of choice has been an appendectomy and a primary hernia repair. Since the emergence of laparoscopy, this is undoubtedly an option. However, the treatment of the appendix remains in most reports as an appendectomy. Successful appendix-sparing treatment of De Garengeot's hernia via laparotomy or laparoscopy has been described, mainly since the COVID-19 pandemic. Case presentation: We report a new case of an 80-year-old woman with an incarcerated De Garengeot's appendiceal femoral-crural hernia, successfully treated entirely laparoscopically. She had noticed the protrusion of a lump in her right inguinal region for two months. Radiological studies, ultrasonography (US), and computed tomography (CT) were inconclusive. Due to the failure in the preoperative diagnosis, a minimally invasive endoscopic approach was performed. Although the distal appendix appeared incarcerated in the femoral ring, there was no evidence of appendicitis. Thus, a fully laparoscopic appendix-sparing transabdominal preperitoneal (TAPP) hernioplasty procedure was undertaken. The patient made an uninterrupted recovery. She did well postoperatively with no complications, left the hospital the same day in a stable condition, returned to complete activities, and has enjoyed good health since. Clinical Discussion: Our literature review shows that in selected cases an appendectomy may be safely avoided, eliminating appendectomy-associated morbidity, and could be considered the first-line alternative when expertise is available. Conclusion: A fully laparoscopic appendix-sparing TAPP approach seems safe and feasible to treat this entity.

Hernia de garengeot, de la teoria a la practica: a propósito de un caso / Garengeot's hernia, from theory to practice: a case report

La Hernia de Garengeot es la presencia del apéndice cecal dentro de una hernia crural atascada/estrangulada. Es una entidad rara de baja incidencia, poco conocida en el mundo, la mayoría son diagnosticadas durante el acto quirúrgico. El objetivo del presente artículo es exponer un caso de Hernia de Garengeot, diagnosticada y tratada en el Hospital Municipal Los Pinos, en una paciente de 67 años; que tras la revisión sintomatológica y semiológica, se dio el diagnostico de Hernia Crural Derecha Estrangulada, fue programada para cirugía de urgencia y en el acto quirúrgico tras la apertura del saco herniario se identificó el apéndice cecal dentro del mismo. Por la atipia del cuadro se enfocara aspectos históricos, etiológicos y fisiopatológicos; que implica tomar en cuenta para dirigir el tratamiento más adecuado según hallazgos y estado del paciente, en esta variedad poco frecuente de hernias.

Garengeot hernia is the presence of the cecal appendix within a stuck/strangulated crural hernia. It is a rare entity of low incidence, little known in the world, most are diagnosed during the surgical act. The objective of this article is to present a case of Garengeot Hernia, diagnosed and treated at the Los Pinos Municipal Hospital, in a 67-year-old patient; that after the symptomatological and semiological review, the diagnosis of Right Crural Hernia Strangulated was given, it was scheduled for emergency surgery and in the surgical act after the opening of the hernial sac the cecal appendix was identified within it. Due to the atypia of the picture, historical, etiological and physiopathological aspects will be focused; which implies taking into account to direct the most appropriate treatment according to findings and condition of the patient, in this rare variety of hernias.

Combined Laparoscopic Open Surgical Approach for De Garengeot's Hernia Containing an Inflamed Appendix: A Case Report.

De Garengeot hernia represents a rare variant of femoral hernia in which the appendix is a part of the hernial contents. It was first described in 1731 by a French surgeon, René de Garengeot. In 1785, Hevin was the first to perform an appendectomy to address acute appendicitis within the context of a femoral hernia. The development of acute appendicitis in the femoral hernia sac becomes a surgical emergency of the acute abdomen.

[De Garengeot hernia - a case report].

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.

The de Garengeot hernia chicken-and-egg conundrum: Acute appendicitis in an incarcerated femoral hernia, but which came first? A case report.

INTRODUCTION: De Garengeot hernia is exceedingly rare and denotes a femoral hernia containing the appendix, which may or may not be inflamed. Given its low incidence, there is no clear consensus on the ideal surgical management of a de Garengeot hernia. PRESENTATION OF CASE: This is a case report of an 81-year-old man who was admitted and operated on for a strangulated femoral hernia containing an inflamed appendix. Appendicectomy and primary hernia repair were performed in tandem using a single incision. DISCUSSION: The case presented here provides a unique account of a subacute presentation of a de Garengeot hernia. It draws into question the true pathogenesis of appendicitis in this clinical setting, by lending credence to the theory that appendicitis can arise sporadically within a long-standing de Garengeot hernia, given the subacute-on-chronic nature of the patient's presentation. Furthermore, the case presented herein represents the minority of cases in which the diagnosis is clinched preoperatively based on computer tomography imaging as, in the vast majority of cases, definitive diagnosis is not made until the time of operation. CONCLUSION: Due to the lack of prospective studies and randomised controlled trials, a standardised, evidence-based approach for the optimal surgical management of de Garengeot hernias remains elusive. Early recognition and diagnosis as well as an individualised approach that considers the patient's anatomy and clinical status are crucial to the management of De Garengeot hernias.

Femoral Hernia Containing a Strangulated Appendix: A Hybrid Approach.

We present an intriguing case of an incarcerated femoral hernia containing an inflamed appendix inside the sac, also known as a De Garengeot hernia. This type of hernia is a rare occurrence that was first described in 1731 by the French surgeon René-Jacque Croissant de Garengeot. A 64-year-old woman presented to the emergency department with a painful mass in the right groin region. Following a computed tomography (CT) scan of the abdomen and pelvis to evaluate the mass, the diagnosis of a femoral hernia containing a strangulated appendix was established. Subsequently, a hybrid surgical approach was utilized, consisting of an open hernia repair and a laparoscopic appendectomy.

De Garengeot's hernia patients entirely treated laparoscopically: a safe and feasible alternative-a systematic review.

PURPOSE: Less than 450 cases of femoral hernias containing the vermiform appendix have been published since De Garengeot's first description. A laparoscopic treatment option opened 15 years ago seems reliable and safe. A literature review of all the patients who have benefited from this new therapeutic alternative is presented. METHODS: A systematic review using the German Society of Surgery's recommendations was performed for De Garengeot's hernias totally treated laparoscopically. Keywords searched included "De Garengeot hernia" OR "femoral hernia appendix" OR "crural hernia appendix." RESULTS: Only 29 out of 225 De Garengeot hernia's manuscripts were identified describing patients entirely treated laparoscopically: 25 patients by a transabdominal preperitoneal hernia repair (TAPP) and 4 patients by a total extraperitoneal (TEP) procedure; 85.1% were females. The mean age was 71 years. Twenty-two patients had pre-operative imaging tests, sonography (2), computed tomography (14), or both (6). Nevertheless, only 56% had a preoperative diagnosis. Twenty-one cases required urgent treatment, while programmed surgery was possible in 7 instances. An appendix-sparing procedure could be done in 16% of the TAPPs. No postoperative complications occurred. The median hospital stay was 2.5 days. CONCLUSIONS: The best surgical approach for a De Garengeot's hernia is not defined, and many critical questions remain unanswered. A better understanding of the diagnosis and treatment of this peculiar hernia will supply guidelines for clinicians who may encounter it hereafter. A fully laparoscopic approach seems perfectly safe and feasible for this entity, and it could be considered the first-line alternative if enough expertise is available.

Strangulated femoral hernia with appendicitis: A rare case of De Garengeot's hernia.

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.

A case report of a combined laparoscopic and open approach for a De Garengeot hernia.

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.

De Garengeot's hernia: A masked abdominal perforation.

INTRODUCTION: de Garengeot's hernias occur when an inflamed appendix is encased within a femoral sac. This is a relatively rare type of femoral hernia. As a result, there are currently no guidelines for the management of these hernias. CASE: We present a 90-year-old woman with a de Garengeot's hernia complicated with strangulation and perforation. The diagnosis was made intraoperatively, and it was managed with hernia repair and an appendicectomy. There were no postoperative complications. DISCUSSION: The presentation of de Garengeot's hernias is non-specific. Enclosure of the bowel content within the hernia sac may mask systemic systems of disease. Rarely, septic signs or symptoms are identified on presentation. It is typically diagnosed intraoperatively, thus prompt emergency surgery should not be delayed by clinicians awaiting precise knowledge of the sac content via imaging. Prompt surgery with a single McEvedy incision enables treatment for both the appendicitis and abdominal wall defect, an appendectomy and hernia repair, respectively. In patients that present with an irreducible femoral hernia and biochemistry suggestive of an acute inflammatory process, there should be a high clinical suspicion for de Garengeot's hernia due to the risk of perforation being masked by an anatomical encasement around the perforated bowel content.

Hernia de Garengeot / Garengeot's Hernia

Introducción: La hernia de Garengeot es una de las hernias de la pared abdominal más infrecuente del mundo. Objetivo: Presentar una paciente con diagnóstico de hernia crural, con el apéndice cecal, lo cual constituye la hernia de Garengeot. Caso clínico: Paciente femenina de color de piel blanca, de 56 años de edad, con antecedentes de salud, que ingresó en el Servicio de Cirugía del Hospital Universitario "Manuel Ascunce Domenech" con el diagnóstico de hernia crural atascada. Presentó dolor en la raíz del muslo derecho, náuseas y presencia de una tumoración por debajo de la línea de malgaigne, irreductible. Conclusiones: La hernia de Garengeot es una entidad quirúrgica única, difícil de distinguir de una hernia crural irreductible. Por tanto, su diagnóstico es un hallazgo intraoperatorio y la herniorrafia es el proceder quirúrgico más empleado(AU)

Introduction: Garengeot's hernia is one of the most uncommon abdominal wall hernias worldwide. Objective: To present the case of a patient with a diagnosis of crural hernia, with cecal appendix, definitely being Garengeot's hernia. Clinical case: A female patient of white skin color, aged 56 years old, with a family history of disease, was admitted to the surgery service of Hospital Universitario "Manuel Ascunce Domenech" with the diagnosis of incarcerated crural hernia. He presented pain in the root of the right thigh, nausea and an irreducible tumor below the Malgaigne's line, irreducible. Conclusions: Garengeot's hernia is a unique surgical entity, difficult to distinguish from an irreducible crural hernia. Therefore, its diagnosis is an intraoperative finding and herniorrhaphy is the most commonly used surgical procedure(AU)

De Garengeot Hernia: A Total Extraperitoneal Approach to a Femoral Hernia Repair.

Introduction: A de Garengeot's hernia is a femoral hernia containing the appendix and accounts for approximately 0.8% of all femoral hernias. Presentation of the Case: This paper describes a case of an 84-year-old female who presented with abdominal pain, believed to have an incarcerated femoral hernia. Patient underwent a hernia repair and was found to have a femoral hernia involving the appendix, a de Garengeot's hernia. The femoral hernia was repaired using a total extraperitoneal (TEP) approach. Discussion: There are a variety of reported ways to repair a de Garengeot hernia. In this case, we discuss the successful use of the TEP approach to repairing a de Garengeot hernia. Conclusion: Although rare, a de Garengeot hernia must remain on the differential when evaluating a patient for an incarcerated femoral hernia. A TEP approach provides the surgeon the ability to perform a variety of hernia repairs, regardless of what is encountered during the operation.

Hernia of De Garengeot an up to date of diagnosis, initial management and treatment: a narrative review and a case study report / Hernia de De Garengeot: diagnóstico, manejo inicial y tratamiento actualizados: una revisión narrativa y un informe de estudio de caso

INTRODUCTION A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases cited in the literature and 5 to 15% of all femoral hernias. CASE PRESENTATION A 53-year-old woman presented to the emergency room of our hospital in our ward with acute onset of a right-sided inguinal swelling that occurred earlier that day after performing a heavy lift. Her examination revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the tip of the appendix was incarcerated within the hernial sac. She was removed through the open inguinal incision after the base of the appendix has been divided laparoscopically. The final pathology showed acute inflamed appendicitis with no evidence of neoplasm. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of appendicitis such as well as surgical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION De Garengeot's hernia remains a rare and unusual surgical presentation of femoral hernia, and the complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach that should be personalized for each patient