Femoral hernias accounting for 2–4% of all hernias rarely involve appendicitis, known as De Garengeout hernia, with only a few reported cases. We present a case of a 66-year-old woman with acute right groin pain but no signs of intestinal obstruction. Physical examination revealed a tender, partially reducible mass in the right groin. Computed tomography scan confirmed a femoral hernia containing incarcerated bowel loops, leading to urgent surgical intervention. The McEvedys approach was used for appendicectomy and hernia repair. The patient recovered without complications. Strangulated femoral hernia with the appendix is a rare condition posing diagnostic challenges. Early recognition is crucial to prevent complications like perforation and abscess formation. Cross-sectional imaging aids in diagnosis. Surgical intervention, either open or laparoscopic, is the preferred treatment, based on surgeon expertise and patient-specific factors. Timely diagnosis and prompt surgery minimise complications.