Case of the Month, May 2018, Case 2

Submitted by  Phong Ha, MD, and Thomas Learch, MD.

Presentation

Fifty-seven-year-old female presents to the E.D. with right groin pain and bulge. Pain began approximately 2 weeks ago after episode of straining at the gym. Groin bulge was discovered 2 days prior to presentation. Both pain and bulge improve when lying down and worsened when ambulating.

  • ROS: positive for nausea, abdominal pain. No changes in bowel function.
  • Physical exam: Tenderness to palpation in right groin area with small mass lateral to the pubic bone. Mass was not reducible.
  • Labs are unremarkable.

Ultrasound

Ultrasound was ordered which showed a right femoral hernia containing “small bowel” and fluid.

Surgery was subsequently consulted and ordered CT pelvis with contrast.

Computed Tomography

 

 

 

 

 

 

 

CT pelvis revealed a right femoral hernia containing the tip of the appendix with adjacent fluid and stranding concerning for an incarcerated appendix.
 
Patient was taken to the O.R. and underwent open femoral hernia repair and laparoscopic appendectomy for strangulated gangrenous tip of appendix within right femoral hernia.

Diagnosis

Strangulated De Garengeot hernia.

De Garengeot hernias are femoral hernias that contain the appendix. It was first described by a French surgeon, Rene De Garengeot, in 1731. It is a rare phenomenon with only 1% of all femoral hernias containing the appendix and only 0.08-0.13% containing an incarcerated acute appendicitis. There is a predisposition for females (1:13) following the increased frequency of femoral hernias in women overall.
A variant of this is the Amyand hernia, which is an appendix-containing inguinal hernia.

Treatment is emergency surgery for hernia repair and appendectomy.

Resources

  • Talini C, Oliveira LO, Araújo ACF, Netto FACS, Westphalen AP. De Garengeot hernia: Case report and review. International Journal of Surgery Case Reports. 2015;8:35-37.
  • Coskun A.K., Kilbas Z., Yigit T., Simsek A., Harlak A. De Garengeot’s hernia: the importance of early diagnosis and its complications. Hernia. 2012;16:731–733.

 

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