Hernia of De Garengeot an up to date of diagnosis, initial management and treatment: a narrative review and a case study report / Hernia de De Garengeot: diagnóstico, manejo inicial y tratamiento actualizados: una revisión narrativa y un informe de estudio de caso

INTRODUCTION A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases cited in the literature and 5 to 15% of all femoral hernias. CASE PRESENTATION A 53-year-old woman presented to the emergency room of our hospital in our ward with acute onset of a right-sided inguinal swelling that occurred earlier that day after performing a heavy lift. Her examination revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the tip of the appendix was incarcerated within the hernial sac. She was removed through the open inguinal incision after the base of the appendix has been divided laparoscopically. The final pathology showed acute inflamed appendicitis with no evidence of neoplasm. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of appendicitis such as well as surgical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION De Garengeot's hernia remains a rare and unusual surgical presentation of femoral hernia, and the complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach that should be personalized for each patient

Hernia de Garengeot: presentación de un caso y revisión de la literatura / De Garengeot hernia: a case report and literature review

INTRODUCTION: Femoral hernias have a high risk of strangulation or obstruction, and their acute presentations are associated with a high risk of mortality, occurring in up to 60% of cases with complications. The presence of the appendix within the femoral sac has been described in a maximum of 1% of cases, which has been called Garengeot hernia, but only 0.08% with concomitant appendicitis. CASE REPORT: Woman 56 years old, cholecystectomized, with no other relevant history, 5 months of evolution, right femoral region volume increase, consultation for 24 hours of evolution of habitual pain exacerbation, CT scan showing complicated hernia, with appendix inside of the hernial sac. The right inguinal approach is performed, the cecal appendix is the only content within the hernial sac, with signs of acute appendicitis, appendectomy and hernia repair with Prolene mesh. Diagnosis is confirmed with biopsy. DISCUSSION AND CONCLUSION: Acute appendicitis within De Garengeot's hernia is extremely rare and often difficult to diagnose. The diagnosis of a femoral hernia appendicitis is often obscured by nonspecific clinical findings that indicate a complicated hernia. Computed tomography may be useful to definitively diagnose acute appendicitis contained within a femoral hernia. It is important to always consider De Garengeot hernia as a differential diagnosis in patients with inguinal mass of acute pain, so as not to delay its detection and management.

Hernia De Garengeot / De Garengeot hernia

Las hernias contenedoras del apéndice cecal constituyen una rareza en la práctica médica habitual. Descritas por De Garengeot y Amyand hace más de 250 años, sigue siendo sorprendente el hallazgo intraoperatorio de un saco herniario que contenga este órgano. Objetivo: describir un caso de hernia De Garengeot. Presentación de caso: se presenta el caso de una paciente de 84 años que acudió a consulta de urgencias por presentar hernia crural irreductible y cuadro clínico sugestivo de oclusión intestinal mecánica. Intervención: se realizó laparotomía exploratoria. Durante el acto quirúrgico se encontró un tumor de la unión rectosigmoidea como causa de la oclusión intestinal y el apéndice vermiforme como contenido de la hernia crural. Se realizó apendicetomía, herniorrafia crural y transversostomía descompresiva en asa. Por las características de los canales inguinal y crural, la presencia del apéndice cecal en el interior de estos es infrecuente, por lo que el diagnóstico de este tipo de hernia es generalmente transoperatorio. Conclusiones: la hernia De Garengeot debe ser más comentada y difundida en los textos convencionales de cirugía por ser una afección bien descrita y tipificada en la historia de la cirugía moderna y que, igual que otros tipos de hernias, como la de Littré y Maydl, es una entidad poco frecuente; su diagnóstico tardío tiene un elevado riesgo para el paciente.

The cecal appendix wrapper hernias are rare in medical practice. Described by De Garengeot and Amyand over 250 years ago, the intraoperative finding of a hernia sac containing this body is still surprising. Objective: to describe a case of De Garengeot hernia. Description: a case of an 84 year- old female patient, who came to the emergency room for consultation due to irreducible femoral hernia and a suggestive clinical condition of mechanical intestinal obstruction, is presented. Intervention: exploratory laparotomy was performed. During surgery a tumor in the rectosigmoid junction is found as a cause of intestinal obstruction and the vermiform appendix was found to be the content of this femoral hernia. Appendectomy and decompressive loop transversostomy are performed. Due to the characteristics of inguinal and femoral canals, the presence of the appendix within these canals is uncommon; that is why the diagnosis of this type of hernia is usually intraoperative. Conclusions: De Garengeot hernia should be more widely discussed in conventional surgery texts since it is a condition to be well described and typified in the history of modern surgery which, like other types of hernias, as Littre and Maydl, is a rare entity. Its late diagnosis is high risk to the patient.