The De Garengeot hernia: A case report of an unusual presentation of appendicitis

Sharma, Davek; Katsnelson, Jacob; Nwachuku, Emmanuel; Kolff, Jeffrey W.

doi:10.1016/j.ijscr.2020.08.053

Cited by 10 publications

(11 citation statements)

References 9 publications

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“…De Garengeot hernias are much rarer than Amyand hernias, with a reported incidence of 0.5% to 5.0% of all femoral hernias[ 6 ]. Due to the narrow femoral ring, a De Garengeot hernia has a much higher risk of strangulation than an Amyand hernia[ 7 ]. De Garengeot hernias are difficult to diagnose before surgery; thus, they are easily misdiagnosed and may be missed clinically.…”

Section: Discussionmentioning

confidence: 99%

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

Yao¹,

Yi²,

Yang³

et al. 2021

WJCC

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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.

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Section: Discussionmentioning

confidence: 99%

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

Yao¹,

Yi²,

Yang³

et al. 2021

WJCC

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“…The preoperative diagnosis remains challenging since the clinical manifestations of De Garengeot's hernia are non-specific [9] , and generally, the diagnosis is incidentally made intra-operatively. Physical findings include a non-reducible inguinal bulge associated with abdominal pain [7] , [10] , and local inflammatory signs are reported in one-third of the cases [11] . The peritonism signs are atypical since the narrow diameter of the femoral ring keeps the inflammatory process limited within the hernia sac [8] .…”

Section: Discussionmentioning

confidence: 99%

“…While there is no consensus or clear recommendations about the best surgical approach to be carried out [10] due to the literature scarcity related to this subject, appendectomy and hernia repair remain the gold standard [13] .…”

Section: Discussionmentioning

confidence: 99%

De Garengeot hernia doubly complicated: A case report

Mejri

Omry

Arfaoui

et al. 2021

International Journal of Surgery Case Reports

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Introduction A strangulated De Garengeot's hernia with appendicitis is an extremely rare surgical presentation. Therefore, the diagnosis is challenging, and there are no recommendations regarding a specific surgical approach. Presentation of case We present the case of a 56-year-old woman with a De Garengeot's hernia doubly complicated: strangulated and with appendicitis in the hernia sac. The diagnosis was made intraoperatively, and it was managed fully through a single inguinal incision. No postoperative complication was presented, and the patient was discharged 48 h after. Discussion The clinical presentation of this sub-type of hernia is non-specific. Precise knowledge of the hernia sac content preoperatively is not mandatory, and it should not delay prompt emergency surgery. As long as there are no local signs of complicated appendicitis, a single inguinal incision may be sufficient to perform appendectomy and hernia repair. In the event of complicated appendicitis, an exploratory of the abdominal cavity is mandatory, and hybrid approaches are recommended. For an experienced surgeon, the laparoscopic approach (TAPP), including the treatment of the two pathologies and the exploration of the peritoneal cavity, represents the surgical technique of choice. Conclusion De Garengeot's strangulated hernia with appendicitis is an exceedingly rare double surgical emergency. When uncomplicated appendicitis, a single inguinal incision is sufficient to treat both appendicitis and abdominal wall defect. Hernia reduction, which young surgeons in the emergency room commonly attempt, should be abolished.

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“…The most common complication of acute appendicitis is perforation, and the rate of perforated appendicitis decreases with age starting as high as 83% in neonates [ 4 ] and decreasing to 11 to 32% in children aged 5 to 12 [ 5 ]. Atypical presentations of appendicitis include appendicitis occurring in inguinal [ 6 ] and femoral [ 7 ] hernias, intussusception of the appendix [ 8 ], and appendicitis causing scrotal abscesses [ 9 ]. Rarer still is the development of a bronchoperitoneal fistula after perforated appendicitis.…”

Section: Introductionmentioning

confidence: 99%