Jacqueline Hawthorne
Hunter New England Health, Australia
Title: Appendicitis in an Incarcerated Femoral Hernia: a case of De Garengeot Hernia
Biography
Biography: Jacqueline Hawthorne
Abstract
Introduction
The finding of an incarcerated femoral hernia containing the appendix is a rare phenomona occuring in less than 1% of fermoral hernias. 0.08-0.13% of femoral hernias contain an incarcerated acute appendicitis. These are known as De Garengeot hernias. Often diagnosis occurs at operation due to lack of symptoms of acute appendicitis (1).
Presentation of Case
68 year old female presented with painful right groin lump for several weeks. She did not have any obstructive symptoms. Ultrasound reveled an incarcerated femoral hernia, CT scan confirmed righ femoral hernia comntaining a loop of small bowel. Laporatory findings showed a normal white cell count and c-reactive protein. A diagnostic laparoscopy was performed identifying a right femoral hernia containing the appendix. A sub-total laparoscopic appendicectomy was performed as well as an open right femoral hernia repair, through which the tip of the appendix was removed. Histopathology confirmed acute appendicitis. She recovered well.
Discussion
Pre-operative diagnosis is extremely difficult in De Garengeot hernia. Radiological studies are usually non-specific, or may identify a femoral hernia with incarceration, despite a lack of symptoms suggestive of small bowel obstruction. Laporatory results are also non-specific. In hindsight, the suggestion of small bowel in the femoral hernia with a lack of symptoms was the key to the diagnosis of De Garengeot hernia. It is unclear whether the appendix became inflammed due to being inside the femoral hernia or whether the patient developed acute appendicitis which then migrated into the femoral hernia.