P-137 DE GARENGEOT`S HERNIA: AN UNUSUAL PRESENTATION OF APPENDICITIS. CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

Abstract Introduction The presence of the appendix within a femoral hernia was first described by René De Garengeot in 1731. Less than 200 cases have been reported in the literature with an incidence of 0.5–5% of all the femoral hernias. Case Description A 69-year-old woman presented with a 72-hour history of painful right-sided groin swelling. She denied fever or any gastrointestinal symptomatology. Clinical examination revealed a non-reducible right mass. X-ray did not show any bowel obstruction. Laboratory found an increased leukocyte count (14.10 K/μL) with 77% neutrophils. She underwent emergency surgery. An inguinotomy was performed, observing the presence of the appendix incarcerated within the femoral ring. It showed clinical signs of appendicitis with no presence of abscess or perforation. Appendectomy was performed. The hernia was repaired with a polypropylene plug fixed to Cooper's and Gimbernat's ligaments. Discussion De Garengeot`s hernia affects women four times more compared to men. The most common symptoms are tenderness and a groin bulge (usually right-sided). The diagnosis is usually performed intraoperatively, although CT-scan is useful as a complementary test. Due to its low incidence, there are still no standardized recommendations on the treatment of this type of hernia. The most common approach in the literature is an open surgery via inguinal incision. Laparoscopic approach has been described too. Mesh use should not be considered in a contaminated field. Conclusion The treatment of this entity is the emergency surgery. We should consider this type of hernia to make an early diagnosis in order to prevent complications.