A Rare Case Of De Garengeot Hernia, The Presence Of Appendix Within A Femoral Hernia.
Department of general surgery, South Infirmary Victoria Hospital Cork City.
Intro: A De Garengeot hernia is defined by the presence of a vermiform appendix within a femoral hernia sac. It was first identified by the French surgeon Rene Jacques Croissant de Garengeot in 1731 and is a rare occurrence accounting for < 1% of femoral hernias. To date, there has been less than 90 cases reported in the literature.
I wish to submit the case of an 82 year old lady who was referred by her GP with a five month history of a right groin lump, approximately 1 cm in size. However, she had recently noticed that the lump had decreased in size. Otherwise, she was completely asymptomatic. Her Background history is significant for breast cancer, Hysterectomy and hypertension. An ultrasound was arranged by her GP prior to review in clinic and this suggested right necrotic lymphadenopathy, the largest estimated to be 2.5 cm in the shortest diameter. It was advised that she have a CT TAP to rule out recurrence. The report stated that the abnormality seen on US represented a normal appendix within a right inguinal hernia. She was reviewed in our clinic and on clinical exam, it was determined that she had a femoral hernia. Due to the high risk of complications with a femoral hernia, she was advised to have surgical repair.
She had an elective low approach femoral hernia repair. Access to the groin lump was via a low oblique transverse right inguinal incision. Appendectomy was performed and sac reduced.
An incidental finding of the appendix and a small amount of serous fluid within a femoral hernia sac was noted. She had an uneventful post operative course and was discharged home on the same day.
This case highlights a rare occurrence of a De Garengeot hernia. The incidence of such hernias is low and their pre-operative diagnosis is both clinically and radiologically challenging.