De Garengeot hernia with avascular necrosis of the appendix: A case report

Abstract

BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain. There are various types of incarcerated hernias, including incarcerated hernias of the appendix. These hernias are often complicated by appendiceal inflammation, necrosis, and suppuration, which affect the outcome of surgical repair. A De Garengeot hernia is a femoral hernia that contains the appendix. This type of hernia has a low incidence. When a De Garengeot hernia is clinically suspected, emergency surgical treatment should be performed as soon as possible. CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier. Physical examination revealed a 4 cm × 2 cm palpable mass in the right groin. The mass was hard and could not be reduced due to tenderness. It did not descend into the scrotum. B-ultrasound revealed an incarcerated hernia. During surgery, the hernia was found to contain the appendix, which exhibited distal avascular necrosis. A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia. Laparoscopic reduction of the incarcerated hernia, appendectomy, and small-incision femoral hernia repair were performed in the emergency department, and cefuroxime was administered as anti-infection therapy for 2 d postoperatively. After treatment, the patient had no abdominal pain or infection and was discharged on postoperative day 4. He had no recurrence of the inguinal hernia after 16 months of follow-up. CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose. Laparoscopy is useful for their diagnosis and treatment.

De Garengeot hernia in an elderly female: a case report

“…18 The treatment of De Garengeot hernia is an emergency, as it is for any femoral hernia incarcerated. 9,19 After initial resuscitation, if needed, with intravenous fluid and analgesia, surgical treatment is mandatory without further delay. Often, it may be associated with acute appendicitis, regardless of the origin of the inflammatory process.…”

“…23 On what concerns about the appendix-preserving elective herniorrhaphy/hernioplasty, according to some studies, it seems to be an acceptable procedure if pre-operative imaging and intraoperative findings do not suggest acute appendicitis or circulatory compromise in the appendix. 9,17,24…”

“…7 Due to is rarity and lack of typical symptoms, preoperative diagnosis is very difficult, but whenever achieved surgical treatment should be done as soon as possible. 8,9 At admission she had low grade fever (38.2ºC) and a tender hard lump, painful and not reducible, could be palped bellow the inguinal ligament. No signs of peritoneal irritation were present at that time.…”