Littré meets de garengeot: meckel’s diverticulum and appendix in a femoral hernia

Racy, M. C. J.; Subramanian, R.

doi:10.1308/003588413x13629960047399

Cited by 10 publications

(10 citation statements)

References 7 publications

(10 reference statements)

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“…The caecum was incarcerated along with the appendix in two patients: in one, reduction was possible after dilation of the hernia canal [36], and in the other, a right hemicolectomy was performed [21]. In four patients, a segment of the small bowel was found in the hernia; however, bowel resection was not necessary [1, 26, 39, 69], and in two patients with a concomitant Littre’s hernia, the bowel was resected [48, 51]. The finding of additional hernia contents indicates a larger entrance to the hernia; however, there was no previous history of hernia in any of these patients.…”

Section: Demographics and Clinical Presentationmentioning

confidence: 99%

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%

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

Linder

Månsson

2018

Hernia

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“…A protrusion of a MD through a potential abdominal opening was first described by the French surgeon Alexis de Littre in 1700 [2]. The usual sites of these so-called Littre hernias are inguinal (50%), umbilical (20%), and femoral (20%) [3]. A Littre hernia occurs in less than 1% of patients with a MD [3].…”

Section: Discussionmentioning

confidence: 99%

“…The usual sites of these so-called Littre hernias are inguinal (50%), umbilical (20%), and femoral (20%) [3]. A Littre hernia occurs in less than 1% of patients with a MD [3]. An MD incarceration in femoral hernia like in the case report at hand is very rare.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Treatment of an Incarcerated Meckel’s Diverticulum in a Femoral Hernia

Paasch

Santo

Look

et al. 2019

Case Reports in Surgery

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Meckel’s diverticulum (MD) is the persistence of the omphalomesenteric duct. It is usually asymptomatic but may present with bleeding, infections, and intestinal obstruction. It also may be a content of a hernia sac, a so-called Littre hernia. Herein, we will present the case of a 75-year-old female, who suffered from a painful swelling of the right inguinal region. Ultrasound imaging detected an inguinal hernia with incarcerated blind ending small bowel. Immediately, a laparoscopy was conducted. We diagnosed a right femoral hernia with an incarcerated MD. A TAPP (transabdominal preperitoneal) procedure was performed and the MD tangential stapled. Due to an uneventful postoperative course, the patient left the hospital after two days. An incarceration of a MD in a femoral hernia is rare. Tangential resection of the MD with simultaneous hernia repair in a TAPP technique seems to be a sufficient approach, when it is conducted by an experienced surgeon.

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“…A few reports of de Garengeot’s hernia exist in the literature – defined as the presence of an appendix within the femoral hernial sac [4,5] . One case reports the presence of a de Garengeot hernia in conjunction with a Littré hernia within a hernial sac, while another describes it in conjunction with a Richter’s hernia [6,7] . There are also reports of the unusual herniation of a fallopian tube and a bladder diverticulum through a femoral hernial sac [8,9] .…”

Section: Discussionmentioning

confidence: 99%