De Garengeot hernia: A case report and review of the literature

Abstract

The earliest description of the appendix protruding through a femoral hernia is by the French surgeon De Garengeot in the 18^th century. He reported a female patient with irreducible, painful thigh swelling that progressed to skin redness. Surgery, intended to drain an abscess, instead found a strangulated femoral hernia with purulent material and an appendix-like structure. Management involved reducing the appendix and allowing the wound to granulate. Later, in 1735, Claudius Amyand recorded the first appendectomy via an inguinal hernia, and in 1785, Hévin authored the initial paper on operating for femoral appendicitis. Akopian and colleagues later coined the term "De Garengeot hernia" to honor this first description. These hernias are uncommon, with an incidence of 0.15% to 5% among femoral hernias. The diagnosis is always mistaken for an incarcerated groin hernia. This is partially due to the difficulties in diagnosing the hernia and also due to its propensity for incarceration because of its anatomy. During surgery, the appendix itself, either perforated or strangulated, is most commonly encountered within the hernia sac. In very rare cases, only appendiceal pus is found in the hernia sac. We report a rare case of De Garengeot’s hernia of a 72-year-old woman diagnosed with acute appendicitis with obstruction in the femoral canal.