Introduction The COVID-19 pandemic has led to drastic measures being implemented for the management of surgical patients across all health services worldwide, including the National Health Service in the United Kingdom. It is suspected that the virus has had a detrimental effect on perioperative morbidity and mortality. Therefore, the aim of this study was to assess the impact of the COVID-19 pandemic on these outcomes in emergency general surgical patients. Methods Emergency general surgical admissions were included in this retrospective cohort study in one of the COVID-19 hotspots in the South East of England. The primary outcome was the 30-day mortality rate. Secondary outcomes included the length of stay in hospital, complication rate and severity grade and admission rates to the ITU. Results Of 123 patients, COVID-19 was detected in 12.2%. Testing was not carried out in 26%. When comparing COVID-positive to COVID-negative patients, the mean age was 71.8 + 8.8 vs. 50.7 + 5.7, respectively, and female patients accounted for 40.0 vs. 52.6%. The 30-day mortality rate was 26.7 vs. 3.9 (OR 6.49, p = 0.02), respectively. The length of stay in hospital was 20.5 + 22.2 vs. 7.7 + 9.8 ( p < 0.01), the rate of complications was 80.0 vs. 23.7 (OR 12.9, p < 0.01), and the rate of admission to the ITU was 33.3 vs. 7.9% (OR 5.83, p = 0.01). Conclusion This study demonstrates the detrimental effect of COVID-19 on emergency general surgery, with significantly worsened surgical outcomes.

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