Appendiceal pus in a hernia sac simulating strangulated femoral hernia: a case report

Hsiao, Tien-Fa; Chou, Yenn-Hwei

doi:10.2147/ijgm.s16413

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…Diagnosis may be more difficult when patients present with abdominal pain alone ( n = 10) [39, 59]. A complete abdominal examination includes the inguinal region, thus, avoiding that the condition is not diagnosed until CT is performed [1], or when the patient’s condition has deteriorated [22, 80].…”

Section: Demographics and Clinical Presentationmentioning

confidence: 99%

“…The most common hernia repair was through suture techniques ( n = 61), and with non-absorbable material (Table 5). The two most frequently specified methods were the McVay [29, 58, 80], Cooper ligament suture techniques [46, 61, 65], and the Lichtenstein repair [50]. Many authors refrained from the use a mesh when there was severe inflammation, perforation, or in the presence of an abscess [21, 48, 59].…”

Section: Demographics and Clinical Presentationmentioning

confidence: 99%

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Treatment of de Garengeot’s hernia: a meta-analysis

Linder

Månsson

2018

Hernia

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Purpose de Garengeot’s hernia is a rare entity in which the appendix is located within a femoral hernia and is almost invariably encountered incarcerated in an emergency setting with concomitant appendicitis. In the literature, there are mostly single-case reports. The purpose of the present study was to perform a review of the literature to study the incidence, pathogenesis, demographics, clinical presentation, laboratory and radiological investigations, differential diagnosis, delay in diagnosis and treatment, operative findings, surgical technique, histological findings, the postoperative course, use of antibiotics, and complications regarding de Garengeot’s hernia. Methods A literature search was performed through PubMed with the following search terms, single or in combination: Garengeot, femoral hernia, and appendicitis. Additional references were also found within the articles, and two patients from Uppsala University Hospital were added. Results Between 1981 and 2016, 70 publications were identified, and with the additional two patients, the present series comprised 90 patients There were 75 women (median age 73.0 years) and 15 men (median age 78.0 years). On examination, an inguinal mass was found in 87 patients (97%), which was painful and the cause of primary complaint in 67 patients (74%): the median duration of symptoms was 3 days. Radiological investigations or ultrasound were performed in 67 patients (74%); computed tomography was the most accurate with a positive diagnosis in 23/34 patients. Appendicitis was found in 76 patients, gangrenous in 23, and perforated in 9. The surgical approach was inguinal in 76 patients, including 15 with concomitant laparotomy. The preperitoneal route was chosen in six patients, and laparoscopy alone in four patients. A mesh/plug was used in 22 patients (7/22 normal appendix) and suture repair in 59 (4/59 normal appendix: p < 0.01). Complications were analysed in 79 patients and occurred in 11%. There was no mortality. Conclusions de Garengeot’s hernia is rare, being indistinguishable from an incarcerated femoral hernia in general. A delay in surgery should be avoided but if needed, computed tomography may be used for differential diagnosis. Although there is no standard treatment, mesh material does not appear advisable in the presence of a perforation, and it is beneficial for the surgeons to perform their routine method rather than a specific technique.

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Section: Demographics and Clinical Presentationmentioning

confidence: 99%

Section: Demographics and Clinical Presentationmentioning

confidence: 99%

Treatment of de Garengeot’s hernia: a meta-analysis

Linder

Månsson

2018

Hernia

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“…The tight neck of the femoral canal acts as a seal which limits inflammation and infection in the hernia sac; therefore perforation of the appendix in the hernia sac will rarely present with peritonitis. It has even been reported that, after the spontaneous reduction of a perforated appendix, the hernia neck seals off the infected collection, preventing peritoneal involvement [9]. …”

Section: Discussionmentioning

confidence: 99%

De Garengeot’s Hernia: Two Case Reports with Correct Preoperative Identification of the Vermiform Appendix in the Hernia

Jin

Imtiaz

Nnajiuba

et al. 2016

Case Reports in Surgery

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We present two cases of incarcerated de Garengeot's hernia. This anatomical phenomenon is thought to occur in as few as 0.5% of femoral hernia cases and is a rare cause of acute appendicitis. Risk factors include a long pelvic appendix, abnormal embryological bowel rotation, and a large mobile caecum. In earlier reports operative treatment invariably involves simultaneous appendicectomy and femoral hernia repair. Both patients were correctly diagnosed preoperatively with computed tomography (CT). Both had open femoral hernia repair, one with appendectomy and one with the appendix left in situ. Both patients recovered without complications. Routine diagnostic imaging modalities such as ultrasonography and standard CT have previously shown little success in identifying de Garengeot's hernia preoperatively. We believe this to be the first documented case of CT with concurrent oral and intravenous contrast being used to confidently and correctly diagnose de Garengeot's hernia prior to surgery. We hope that this case report adds to the growing literature on this condition, which will ultimately allow for more detailed case-control studies and systematic reviews in order to establish gold-standard diagnostic studies and optimal surgical management in future.

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