Abstract
BackgroundEmergency 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 descriptionA 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.ConclusionDe 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.
Highlights
Emergency appendectomy is often performed for de Garengeot hernia
De Garengeot hernia is often associated with appendicitis; an appendix-preserving elective herniorrhaphy can be performed if US and intraoperative findings do not suggest appendicitis or circulatory compromise in the appendix
Because de Garengeot hernia is often associated with appendicitis or circulatory compromise of the appendix, most surgeons perform emergent herniorrhaphy with appendectomy [5–7]; there may be a chance to perform an appendix-preserving elective surgery in certain situations
Summary
De Garengeot hernia is a femoral hernia that contains the appendix [1]; its incidence has been reported to be 0.15– 5% of all femoral hernias [2–4]. Laparoscopy showed incarceration of the median umbilical fold into the right femoral ring and the free appendix in the abdominal cavity (Fig. 3, Additional file 2: video S2). Contrast-enhanced CT (Fig. 4) showed a blind-ended tubular structure, 6 mm in diameter and continuous with the cecum with contrast enhancement medial to the right femoral vein, suggesting that it was the appendix. B-mode US showed a blind-ended isoechoic structure (5 mm in diameter) which was continuous with the cecum, a surrounding reticular hyperechoic area, and an anechoic area medial to the right femoral vein, which were diagnosed as the appendix, mesoappendix, and ascites, respectively (Fig. 5a). B-mode US showed a clear appendiceal wall structure, and color Doppler US showed pulsatile blood flow signals in the appendiceal wall (Fig. 5b, Additional file 3: video S3) Based on these findings, she was diagnosed with de Garengeot hernia. The postoperative course was uneventful, and she has no signs of hernia recurrence or appendicitis 5 months postoperatively
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