De Garengeot Hernia Research Articles

Intestinal occlusion secondary to De Garengeot’s hernia resolved by laparoscopy

Introduction: Femoral hernias constitute a minority of abdominal wall hernias and an entrapment of the appendix in the femoral hernia is called Garengeot's hernia. Case report: A 93-year-old woman was admitted to the emergency department of our hospital presenting abdominal pain accompanied by intestinal occlusion. She underwent laparoscopy for a diagnosis of femoral hernia with inflamed cecal appendix inside, with an adequate postoperative period. Discussion: The incidence of De Garengeot hernia is approximately 0.1-5% of reported femoral hernias and 0.1% of acute appendicitis. Conclusion: Despite this uncommon pathology, emergency surgical treatment is generally required, and the laparoscopic approach is the best option as long as the patient's condition and the surgeon's experience allow it.

EP58 - Gangrenous appendicitis in an incarcerated femoral hernia: A rare case of De Garengeot Hernia

Abstract Aims To present a rare case of gangrenous appendicitis within an incarcerated femoral hernia, discussing its clinical background and highlighting the challenges in its diagnosis and surgical management. Methods We detail a 74-year-old female with a painful, non-reducible groin mass. A CT abdomen pelvis revealed a right femoral hernia with acute reactive inflammatory changes, with no comment made on the appendix (Figure 1 and 2). Emergency open femoral hernioplasty and laparoscopic appendectomy were performed. Results Intraoperatively, a femoral hernia with a gangrenous appendicitis were identified. The appendix was reduced into the abdominal cavity to allow for better evaluation of its base. A laparoscopic appendectomy was performed after identifying the healthy base (Figure 3), followed by a femoral hernioplasty. This case sheds light on the rarity not only of the De Garengeot hernia which is defined by the presence of the vermiform appendix within the femoral hernia sac, but also even rarer the finding of a gangrenous appendix within the sac, with a reported incidence from 0.08-0.13% in cases of acute appendicitis. The case emphasizes the importance of considering an acute appendicitis and its complications within a femoral hernia as a differential diagnosis of painful groin masses with raised inflammatory markers. Conclusion Given the scarcity of literature on the surgical management of acute appendicitis in De Garengeot hernias, this case contributes valuable insights. The absence of established guidelines underscores the need for further exploration of optimal surgical strategies in such cases. Our report aims to enhance awareness of this rare presentation and facilitate future discussions on its management.

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.

970 A Parisian Pain in the Groin; a Case of De Garengeot’s Hernia

Abstract Introduction 77-year-old gentleman presented with a four-day history of a painful right sided irreducible groin swelling. Background of previous bilateral mesh inguinal hernia repair thirty years prior. Differential diagnosis- recurrent incarcerated inguinal hernia. Description Emergency presentation with a painful right sided groin lump with history of previous inguinal hernia repair. Past medical history of AF on rivaroxaban, HTN and BPH. Patient systemically well with an irreducible lump in the right groin. CTAP showed recurrence of hernia in right inguinal region containing fat stranding and a 2cm-sized fluid-filled structure (suspected appendix). Taken to theatre the following day - oblique incision in right groin. Obvious femoral hernia identified. Haemorrhagic fluid and a necrotic appendix contained in hernia sac. Open appendicectomy performed through groin incision and femoral canal plicated using 2.0 prolene. No mesh used due to risk of contamination. Discharged day 2 post-op. Pathology confirmed acute appendicitis. Discussion Extremely rare case presentation. Femoral hernias account for 3% of all hernias and De Garengeot hernias only 1% of all femoral hernias. Furthermore, De Garengeot hernia with acute appendicitis accounts for only 0.01% of femoral hernias and are much more common in females than males with a 4:1 ratio. Femoral hernias are fifteen times more common in patients who have undergone previous inguinal hernia repair with 33% of men and 4% of women with De Garengeot hernia having undergone previous right inguinal hernia repair. Difficult pre-operative diagnosis given rarity with only 30% of cases diagnosed on pre-operative imaging-initial diagnosis Amyand hernia on CT imaging.

Laparoscopic Transabdominal Preperitoneal Repair of De Garengeot Hernia: A Case Report

Abstract De Garengeot hernia is a rare type of femoral hernia in which the appendix is contained within the hernial sac. Due to its rarity, there is limited evidence regarding its optimal surgical approach. Twenty-five reports of repair using the laparoscopic transabdominal preperitoneal (TAPP) technique have been identified; however, there is a lack of consensus pertaining to preoperative diagnosis and whether concurrent appendicectomy is performed. In addition, there is debate over the use of a covering mesh. A 34-year-old woman presented with a 5-week history of pain in the right groin. On examination, an irreducible, tender mass was identified in the groin. A computed tomography scan illustrated a right femoral hernia containing the appendix, demonstrating features of acute uncomplicated appendicitis. The patient underwent laparoscopic TAPP repair with mesh plus appendicectomy and made an uncomplicated recovery. Here, we present laparoscopic TAPP repair with mesh plus appendicectomy as a safe and feasible surgical method for managing De Garengeot hernia with concurrent uncomplicated appendicitis.

De Garengeot hernia in an elderly female: a case report

A groin hernia is known as De Garengeot hernia when the appendix is located within the sac of a femoral hernia, with or without associated acute appendicitis. The true incidence of de Garengeot’s hernia is difficult to assess due to its rarity. Most of the times, De Garengeot hernia are presented acutely when incarcerated which turn them indistinguishable from other incarcerated femoral hernias at clinical examination. Treatment of De Garengeot hernia is an emergency, as it is for any femoral hernia incarcerated. After initial resuscitation, surgical treatment is mandatory without further delay. The surgical approach and the options to consider are dependent on the presence of incarceration and of septic environment at the time of diagnosis.

Necrotising soft tissue infection secondary to an incarcerated De Garengeot hernia

De Garengeot hernias are rare and can be difficult to diagnose pre-operatively. This case presented as a right groin abscess with necrotising soft tissue infection extending into the right thigh. At operation, a perforated appendix was found within the femoral canal with a distal loop of small bowel fistulating into the abscess cavity. On review of the literature, this is the first case to be reported describing this finding.

Obstructed femoral hernia with an associated De Garengeot hernia

A De Garengeot hernia is the eponymous name to describe a femoral hernia containing the appendix. Imaging may confirm the diagnosis pre-operatively; however, many are identified at the time of surgery. We describe the case of an elderley female patient who presented with a small bowel obtruction due to an incarcerated femoral hernia, with the unexpected finding at the time of surgery of the appendix additionally within the hernia. Following diagnostic laparoscopy, she underwent a laparoscopic appendicectomy and open suture repair of the femoral hernia.

De Garengeot hernia: A case report and classification

De Garengeot hernia: A case report and classification

An Infantile Left Amyand Hernia: Case Report and Review of Literature

The incidence of incarceration in pediatric inguinal hernia is between 12 to 17% especially during infancy. It may contain small gut, omentum, cecum, appendix, or ovary and uterine tube, and appendix could be incarcerated on the right side (82%) mostly. Hypermobility of cecum which is a triggering factor of Left-sided Amyand’s hernia and an explanation of De Garengeot hernia occurs in 10-20% of population. Herein, a 9-month-infant with a left-sided incarcerated inguinal hernia containing both cecum and appendix was successfully operated through a groin incision. A hypermobile cecum is accused of the left-sided incarcerated Amyand’s hernia. Preservation or removal of the appendix is controversial which depends on the infection or trauma of hernia contents but the definitive repair of hernia is mandatory. Postoperative imaging should be done for exclusion of the possible underlying anomalies as hypermobile cecum, abnormal intestinal rotation, or situs inversus.

A case review of De Garengeot's hernia

De Garengeot's hernia was described in 1731, referring to it as the presence of the appendix in a femoral hernia. It occurs in between 0.5% and 5% of cases. It is believed to perform simple hernia surgery and avoid using mesh if there is infection or inflammation. Laparoscopic surgery should be considered in patients who are clinically stable and have a preoperative diagnosis. In this case, we are dealing with a patient who has a hernia caused by Garengeot's syndrome

A case review of De Garengeot's hernia

A case review of De Garengeot's hernia

P-018 ACUTE APPENDICITIS IN DE GARENGEOT'S HERNIA - A LITERATURE REVIEW

Abstract Aim This study aims to undertake a systematic review of published data, focussing on the incidence of acute appendicitis within a de Garengeot hernia, the relationship between pre-operative diagnosis, surgical technique, incidence and surgical outcomes. Methods A PRISMA modelled literature search was carried out across PubMed, ProQuest, and BMW Case Report databases with the search terms ‘Femoral Hernia’, ‘Appendix’, ‘de Garengeot's’ in combinations, limited to English language, published between 1960 to 2019. Authors report another case study that was not included in the systematic review. Results Systematic review identified 84 published data reporting 112 such cases. 74(66%) presented with painful groin swellings. CT performed in 43(38%) accurately diagnosed de Garengeot's in 32(74%) patients. The most common surgical approach was low approach 35(31%) followed by the inguinal approach 23 (21%). 81 (72%) underwent herniorrhaphy with non-absorbable sutures and 20 had mesh repairs (18%). Ten (9%) patients were reported to have postoperative morbidity with wound infection being the most common complication and one recorded death. Conclusion Rarity of de Garengeot's hernia is shown by the limited availability of data that restricted our ability to conclude a single diagnostic pathway or a specific surgical technique for this condition. CT has shown, relatively accurate form of imaging tool, as well as Ultrasound scans in some. Sequestrated appendicectomy and hernia repair via laparoscopy is an option, however, there is lack of data to warrant its effectiveness as the surgical option of choice over an open groin approach in the presence of incarcerated groin swelling.

TH7.5 De Garengeot hernia: a combination of niche presentation, diagnostic, and anatomical factors

Abstract Background De Garengeot hernias occur in almost 1% of femoral hernias and are diagnosed when the appendix is also present within. They are more commonly observed in post-menopausal women, but their pathogenesis remains controversial. Theories involve abnormalities in bowel rotation during embryological growth, caecum mobility or size, and increased abdominal pressure. Most are diagnosed intra-operatively and are otherwise incidentally discovered on imaging. An advised surgical technique has not been determined due to its rarity; however, most literature suggests laparoscopic hernioplasty and appendicectomy in absence of infection. Case report A 77-year-old female presented with a three-day history of a painless, right groin mass. Blood results were within normal range, and sonography identified a De Garengeot hernia suggesting appendiceal inflammation. She underwent emergency laparoscopic surgery that discovered a strangulated appendiceal tip within an incarcerated femoral hernia, which then unexpectedly divided during manipulation. Additional findings included a broad mesoappendix and lack of appendicitis. The team proceeded with a hernioplasty and appendicectomy, and the patient was discharged two days later without complications. Conclusion This case report highlights a few niche aspects of De Garengeot hernias. Firstly, it is unusual our patient's diagnosis occurred preoperatively via ultrasound; secondly, the ischaemic tip of the appendix unexpectedly self-detached upon mobilisation; and thirdly, the widened mesoappendix likely contributed towards her predisposition to De Garengeot hernias. Overall, our case represents laparoscopic surgery being optimal in treating De Garengeot hernias that are diagnosed preoperatively, and that they should remain a differential diagnosis for non-specific groin lumps, regardless of pain.

EP-70 Gangrenous appendix with an abscess in femoral hernia cavity-a rare case of De Garengeot's hernia

Abstract Background De Garengeot's hernia (DGH) is a Femoral Hernia that contains an appendix and has been named after Rene De Garengeot, a French surgeon in 1731. It is a rare entity that is mostly identified as an incidental finding during exploration of an incarcerated Femoral Hernia and even rarer is the incidence of a gangrenous appendix in these cases. Case An 81 years-old female patient presented to Accident & Emergency complaining of a progressively tender enlarging mass in the right groin region, associated with local inflammation. CT scan of abdomen and pelvis (CTAP) performed showed suspected perforated caecum with large groin abscess. She underwent groin exploration which confirmed femoral hernia sac containing a gangrenous appendix with a surrounding abscess. The abscess cavity extended from the right groin to medial aspect of thigh. Appendectomy was performed, abscess cavity drained and washed with normal saline/ Betadine followed by suture repair of the femoral hernia defect . She made an uneventful recovery following the surgery. Discussion DGH itself is rare surgical pathology with an incidence of about 0.18% to 0.13%, however, the presentation like our case is even rarer. Emergency surgery is the definitive treatment of DGH to avoid any complications. During surgery, appendectomy and femoral hernia repair are performed consecutively. In conclusion, appendicitis within a femoral hernia often lacks a classical presentation. CTAP can be helpful in diagnosis, however there can be limitations. Appendectomy with mesh-free hernia repair is an acceptable treatment for DGH. Keywords De Garengeot hernia, Incarcerated femoral hernia

De Garengeot’s hernia: case report

Introduction: De Garengeot hernia is an entity mainly diagnosed intraoperatively. It is more frequently observed in women and is defined as the presence of the vermiform appendix inside to femoral hernia. Most femoral hernias are identified based on clinical diagnosis, but diagnostic imaging is necessary for confirmation. Ultrasound, for example, is a valuable tool to characterize the anatomy of the hernia and its content, and to establish surgical planning. Case presentation: A 75-year-old woman attended the general surgery department of a high complexity hospital in Bogotá, Colombia, due to a painful mass in the right inguinal region. The initial ultrasound study showed a femoral hernia containing the incarcerated appendix and periappendiceal fluid in the hernial sac. The patient developed chronic appendiceal inflammation, so she underwent femoral hernia repair with mesh and appendectomy without complications, achieving a satisfactory recovery. Conclusion: Clinical examination may be sufficient to confirm the presence of a hernia in a large number of cases when the diagnostic approach involves the search of inguinal masses with pain. However, to facilitate surgical planning, diagnostic imaging, especially ultrasound with high resolution transducers, is the primary tool to characterize the type of hernia and the contents of the hernial sac.

De Garengeot appendicitis

An 87-year-old woman presented with a 1-day history of an enlarging right groin lump with associated localized pain. She had a history of hypertension managed with perindopril. On examination, she had a low-grade fever with a temperature of 37.9 degrees Celsius, was mildly hypotensive with a blood pressure of 97/60mmHg, borderline tachycardic with a heart rate of 95 beats per minute, and was saturating at 95% on room air. On palpation, there was an irreducible and tender lump in her right groin. She was not peritonitic. Her white cell count was elevated at 11.6 × 109/L, and her C-reactive protein was elevated at 20 mg/L. She underwent computed tomography (CT) of the abdomen and pelvis. On review of the imaging (Figure 1), which diagnosis explains this patient’s acute presentation? •Littre hernia with Meckel’s diverticulitis •De Garengeot hernia with appendicitis •Saphena varix •Pantaloon hernia

P155 DE GARENGEOT HERNIA: A CASE REPORT

Abstract Aim “The De Garengeot’s hernia, from Rene De Garengeot, who was the first to describe the appendix inside a femoral hernia sac in 1731, is a rare type of crural hernia. The diagnosis is challenging and surgery must be performed without delay. The incidence of appendicitis in this type of hernia is about 0.08-0.13%. The aim of this work is to describe our experience in the management of this rare subtype of hernia in a 82-year-old women” Material and Methods “A 82-year-old patient with a right groin bulge presented to the Emergency. At the physical examination the abdomen was treatable; there was no sign of bowel obstruction. Blood test values were normal, except for a high PCR value. The US of the groin region demonstrated a right femoral hernia containing a bowel tract, irreducible at the probe’s pressure. The patient underwent surgery, with diagnosis of De Garengeot’s hernia; a direct hernia repair followed by an open appendectomy were performed. The patient did not present any complications and was discharged on the second postoperative day” Results “The De Garengeot hernia is a rare entity that requires an early treatment; the preoperative diagnosis is difficult and often clinical features are similar to a common incarcerated hernia. There are many surgical options for the management of the De Garengeot hernia, but there is not a consensus for the best surgical approach” Conclusions “De Garengeot's hernia is rare, being indistinguishable from an incarcerated femoral hernia in general. This case report is about a De Garengeot’s hernia patient, who presented a good recovery after surgery.”

Appendix-preserving elective herniorrhaphy for de Garengeot hernia: two case reports

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.

1412 De Garengeot's Hernia Complicated by Perforated Appendicitis and Groin Abscess: Report of A Rare Surgical Emergency

Abstract Introduction De Garengeot's hernia is a rare subtype of femoral hernia which contains the vermiform appendix. Acute appendicitis in a femoral hernia is even more unusual, accounting for 0.08% - 0.13% of all cases of femoral hernias. Case presentation A 91-year-old woman was referred with a painful, cellulitic right groin mass. A computed tomography scan demonstrated a right-sided femoral hernia containing a loop of bowel and a collection in the right groin containing fluid and gas. The patient had early dementia but no other major medical co-morbidities. At surgery, she was found to have perforated appendicitis in a right femoral hernia. Most of the appendix and sac had fully disintegrated, forming a large abscess cavity beneath the skin in the right groin which extended down to the upper labia majora. The appendix tip was lying deep within the abscess cavity. A modified McEvedy approach was used to access the peritoneal cavity for the appendicectomy and sutured repair of the femoral neck. The groin abscess cavity was drained and managed with a negative pressure (VAC) dressing. Discussion De Garengeot's hernia is often difficult to diagnose pre-operatively and reporting of cross-sectional imaging may not always be reliable. Currently, there is no gold standard method for repairing these hernias. However, the modified McEvedy approach is well-described and is the preferred technique for emergent femoral hernia presentations. It provides sufficient access to manage both appendicitis and the femoral hernia. Adjuncts such as negative pressures dressings may be used to manage concomitant abscess cavities.