A rare presentation of appendicitis inside the femoral canal: case report and literature review

Abstract

BackgroundFemoral hernia accounts for 3% of all the hernias, and in 0.5–5% of cases, the appendix can migrate through the femoral hernia and is called de Garengeot hernia. It is a very rare condition, and the incidence of appendicitis in this type of hernia is as low as 0.08–0.13%.Case presentationWe bring into discussion a case of a 47-year-old female who presented to the emergency department with a painful right-sided groin lump for the past 2 days. After initial resuscitation, a CT scan was requested which showed the presence of inflamed appendix inside the femoral canal. She was taken to the operative theatre, and during the laparoscopy, the appendix was identified migrating through the femoral canal and it could not be retracted into the peritoneal cavity; therefore, the mesoappendix was divided and the operation converted to the open low approach. After identifying the femoral hernia sac and opening it, the appendix was removed and herniorrhaphy was performed. Our patient had an uneventful recovery and was discharged on the following day.ConclusionWe report a rare case of de Garengeot hernia which was diagnosed preoperatively. Because of its non-specific presentation, patients are usually diagnosed with incarcerated femoral hernia and are taken to operative theatre and the final diagnosis is made intra-operatively. Due to its rarity, there is no standard approach for this condition, and emergency appendicectomy and concurrent herniorrhaphy is the mainstay of treatment. In this paper, we present different surgical methods for the treatment of this type of hernia.

Abordaje de hernias poco frecuentes por cirugía de mínimo acceso: serie de casos

“…14 Cuando el defecto herniario se encuentra en el orificio femoral, se denomina hernia de Garengeot. 15,16 Cuando el contenido del saco de una hernia incluye el borde antimesentérico del intestino delgado, con o sin compromiso de la vasculatura de una porción de la pared intestinal, se denomina hernia de Richter. Generalmente el defecto es inguinal, aunque se han descrito también en defectos femorales, umbilicales o incisionales del sitio de inserción del puerto laparoscópico.…”

De Garengeot Hernia: Case Report and Review of the Literature of a Rare Femoral Hernia

“…A hernia sac can contain any of the intra-abdominal contents. Femoral hernia containing appendix accounts for only 0.5-5% of all femoral hernias [6][7][8].…”

Successful one-stage laparoscopic procedure for de Garengeot hernia: a totally extraperitoneal repair-first approach

“…As hernioplasty and appendectomy are required in general, accurate diagnosis of the appendix situation such as necrosis, perforation and abscess formation is very important for determining appropriate surgical strategy. In a reported case, the hernia could be diagnosed preoperatively, thereby allowing laparoscopic approach selection [ 4 ]. A meta-analysis by Linder et al .…”

“…TAPP requires a peritoneal incision for mesh placement, which may again increase the infectious risk. Infection is a major complication of de Garengeot hernia repair, with an incidence of 14–29% [ 4 ]. While recent studies report that mesh repair for an incarcerated hernia does not increase the infectious risk [ 9 ], a mesh-free repair is recommended in cases of severe inflammation due to perforation or abscess [ 1 ].…”