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Background
Rene Jacques Croissant de Garengeot, a French Surgeon, was the first to describe the presence of the vermiform appendix inside the incarcerated femoral hernia in 1731 hence the name De Garengeot’s hernia.
Femoral hernia occurs as a result of the protrusion of abdominal content through the femoral canal medial to the femoral artery and below the inguinal ring. This hernia is more common in women but accounts for only 3% of all hernias. In only 0.5 - 5% of cases the appendix will travel through the femoral hernia.
Case Presentation
63yo female patient presented to GP with irreducible lump in right groin which she had initially noticed 24 hrs prior. No other clinical symptoms were present at the time.
Urgent ultrasound identified an incarcerated hernia (thought to be Inguinal) with the presence of unexplained fluid around hernia contents. Patient was advised to present to emergency immediately.
On arrival BP slightly elevated, afebrile and pain score was approximately 2. On arrival to Emergency patient was assessed by Emergency team and referred for emergency surgery. Transferred to surgical ward, assessed by surgeon and taken to theatre.
Investigations
Ultrasound prior to presentation to emergency.
Full blood workup
IV inserted
Nil by Mouth
Treatment
Surgical intervention initially was for repair of an incarcerated inguinal hernia as per radiology report. When it became evident that this was not the correct diagnosis, a Laparoscopy was performed to identify the diagnosis of De Garengeot’s femoral hernia with necrotic appendix and bladder wall entrapment.
Release of Femoral Hernia contents including Appendicectomy performed, bladder wall released and hernia repaired. Indwelling catheter inserted and remained insitu for 10 days post operatively due to possibility of compromised integrity of bladder wall post surgery.
Retrograde Cystogram performed on Day 10 showing normal bladder function and IDC removed. Overall, an uneventful recovery was experienced.
Discussion
Treatment of a De Garengeot hernia is an emergency procedure. After the initial treatment of intravenous fluids, antibiotics and analgesia the patient is then transferred to the operating table.
Due to the rarity of the condition, there is no specific guideline for the surgical procedure and this is dependent on the surgeons preference, opinion and the patient’s condition.
The main complications of this procedure are wound infection and, rarely, necrotising fasciitis. It has been found that delay in diagnosis, poor nutritional status, older age and multiple tissue planes involved in the repair of the hernia are contributing factors to increase the incidence of post operative infections. In this case, the patient had an uneventful recovery.
References
Bidarmaghz B, Tee CL. BMJ Case Report 2017. Doi: 10. 1136/bcr-2017-220926 A case of De Garegeot hernia and literature review https://casereports.bmj.com/content/2017/bcr-2017-220926
Misiakos EP, Paspala A, Prodromidou A, Machairas N, Domi V, Koliakos T, Karatzas T, Zavras N, Machairas A. De Garengeot’s Hernia: Report of a Rare Surgical Emergency and Review of Literature. https://www.frontiersin.org/articles/10.3389/fsurg.2018.00012/full
