RS07P DE GARENGEOT HERNIA‐ AN UNUSUAL FINDING IN A RIGHT GROIN MASS

Abstract

The appendix in a femoral hernia is a rare and usually incidental finding at surgery, occurring in 0.5 to 3 per cent of femoral hernia cases [1]. Rarer still is the finding of an acute appendicitis in a femoral hernia, known as a de Garengeot hernia.We present the case of a 47 year old male who presented with a four day history of a painful right groin lump with surrounding erythema of the skin. Ultrasound scan suggested the presence of an incarcerated inguinal hernia, but at operation it was discovered that the appendix was incarcerated in the femoral canal with the tip of the appendix ischaemic. Histology confirmed the presence of an acute appendicitis.External compression of the appendix at the neck of the hernia is thought to be the cause of acute appendicitis within femoral hernias. The narrowness and rigidity of the femoral canal predisposes it to incarceration, but subsequently intraperitoneal spread of infection is limited. Thus the patient presents with local signs such as erythema and groin tenderness – usually excluding typical symptoms of peritonitis.While extremely rare, this case highlights the importance of considering a De Garengeot hernia in the differential diagnosis for a right groin lump. Diagnosis is often only made at the time of surgery.