Hernia de Garengeot / Garengeot's Hernia

Introducción: La hernia de Garengeot es una de las hernias de la pared abdominal más infrecuente del mundo. Objetivo: Presentar una paciente con diagnóstico de hernia crural, con el apéndice cecal, lo cual constituye la hernia de Garengeot. Caso clínico: Paciente femenina de color de piel blanca, de 56 años de edad, con antecedentes de salud, que ingresó en el Servicio de Cirugía del Hospital Universitario "Manuel Ascunce Domenech" con el diagnóstico de hernia crural atascada. Presentó dolor en la raíz del muslo derecho, náuseas y presencia de una tumoración por debajo de la línea de malgaigne, irreductible. Conclusiones: La hernia de Garengeot es una entidad quirúrgica única, difícil de distinguir de una hernia crural irreductible. Por tanto, su diagnóstico es un hallazgo intraoperatorio y la herniorrafia es el proceder quirúrgico más empleado(AU)

Introduction: Garengeot's hernia is one of the most uncommon abdominal wall hernias worldwide. Objective: To present the case of a patient with a diagnosis of crural hernia, with cecal appendix, definitely being Garengeot's hernia. Clinical case: A female patient of white skin color, aged 56 years old, with a family history of disease, was admitted to the surgery service of Hospital Universitario "Manuel Ascunce Domenech" with the diagnosis of incarcerated crural hernia. He presented pain in the root of the right thigh, nausea and an irreducible tumor below the Malgaigne's line, irreducible. Conclusions: Garengeot's hernia is a unique surgical entity, difficult to distinguish from an irreducible crural hernia. Therefore, its diagnosis is an intraoperative finding and herniorrhaphy is the most commonly used surgical procedure(AU)

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

Las hernias de Amyand y Garengeot como expresión del apéndice cecal en la región inguinofemoral / Amyand's Hernia and Garengeot's Hernia as Onset Manifestations of Cecal Appendix in the Inguinofemoral Region

RESUMEN La reparación de la hernia en la región inguinocrural es una de las operaciones más frecuentes en la práctica quirúrgica. Pueden encontrarse hallazgos inusuales, como el apéndice cecal parcial o completamente contenido en el saco herniario, lo que se denomina hernias de Amyand y Garengeot. Se presentan en aproximadamente el 1 por ciento de los pacientes con hernia inguinocrural, mientras que representan cerca del 0,1 por ciento de los casos de apendicitis. Clínicamente se presentan como una hernia inguinocrural incarcerada, y la ecografía o la tomografía axial computarizada pueden ayudar en el diagnóstico preoperatorio. El estado del apéndice cecal determina el acceso quirúrgico y el tipo de reparación herniaria. El objetivo de este artículo es desarrollar un material de apoyo a los profesionales implicados en la atención de estas raras entidades quirúrgicas(AU)

ABSTRACT Hernia repair in the inguinocrural region is one of the most frequent interventions in the surgical practice. Unusual findings can be found, such as the cecal appendix partially or completely contained within the hernial sac, called Amyand and Garengeot hernias. They occur in approximately 1 percent of patients with inguinocrural hernia, while they represent about 0.1 percent of the cases of appendicitis. Clinically, they present as an incarcerated inguinocrural hernia; ultrasound or computed tomography (CT) can assist in the preoperative diagnosis. The state of the cecal appendix determines surgical access and type of hernia repair. The objective of this article is to develop a support material for the professionals involved in the care of these rare surgical entities(AU)

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.

Cirugía laparoscópica de una hernia de Garengeot: presentación poco frecuente de una hernia crural / Laparoscopic Surgery of a Garengeot's Hernia: A rare presentation of a crural hernia

Introducción: La hernia de Garengeot es una rara presentación de una hernia crural. Caso clínico: Se presenta el caso de una mujer de 64 años de edad, que consultó por dolor en fosa ilíaca derecha. Se le realizó una tomografía axial, que mostró un proceso inflamatorio en cuadrante inferior derecho del abdomen. Se le practicó una laparoscopia exploradora, encontrando el apéndice cecal en el anillo crural. Se realizó apendicectomía y reparación de la hernia vía laparoscópica. En nuestra revisión este es el tercer caso publicado en el mundo de resolución laparoscópica, y el primero en Chile.

Background: Garengeot's hernia is a rare presentation of a femoral hernia. Case report: We report a case of a 64 year-old female patient complaining of right lower abdominal pain. She was studied by CT-Scan that showed an inflammatory process in right lower cuadrant. We made an exploratory laparoscopy and found the cecal appendix in the crural defect. We did a laparoscopic appendectomy and crural hernia repair with mesh. To our knowledge, this is the third laparoscopic case published in the world and the first of Chile.

Treatment of De Garengeot's hernia using De Oliveira's technic: A case report and review of literature.

INTRODUCTION: The French surgeon Rene Jacques Croissant de Garengeot first described the finding of the Appendix inside a femoral hernia sac in 1731. The De Garengeot's hernia is a rare entity, comprehending only 0.5-5% of the femoral hernias. The pathogenesis of this entity is still controversial, and in the same way, there are different theories to explain the occurrence of appendicitis inside the De Garengeot's hernia. There is no standard technique in the treatment of this entity. PRESENTATION OF CASE: W.P.S., 84, female, admited for medical assistance due to claims of edema and flogistic signs in the right inguinal region, noted four days prior. There was no abdominal pain, discomfort, or other symptoms. The physical examination showed hard edema and bulging on the right inguinal region, colaborating for the hipotesis of incarcerated hernia. Patient was then submitted to inguinotomy and the vermiform Appendix was discovered inside the femoral hernia without signs of appendicitis. The case was conducted using the De Oliveira's technique to femoral hernia repair and Liechenstein for the inguinal hernia repair. DISCUSSION: The De Garengeot's hernia is a rare entity, comprehending only 0.5-5% of the femoral hernias(2), it represents an unusual finding and is, in the majority of cases, diagnosed intraoperatively. It's pathogenesis is yet matter of discution. There is no standard approach for this hernia, possibly by the few numbers and variability of presentation of cases described. CONCLUSION: This paper presents a case of a 84yo female with De Garengeot's hernia that was submitted to a correction using the De Oliveira's technic. A low cost technic with great results without use of polypropylene mesh.

Amyand hernia: Case report and review of the literature.

INTRODUCTION: Amyand Hernia is a rare disease seen in approximately 1% of all hernias, complications of it, like acute appendicitis, or perforated appendicitis are even more rare, about 0.1%. Its diagnosis is very difficult in the pre-operative period; it is usually an incidental finding. PRESENTATION OF CASE: This paper describes the case of a forty-year-old male patient, which was presented to the outpatient clinic of surgery with an incarcerated right side inguinal hernia without any signs of ischemic complications. He was admitted, and an hernioplasty was performed, as an incidental finding we encountered an Amyand hernia treated without appendectomy and placement of a prosthetic mesh without any complications. DISCUSSION: This disease represents a very challenging diagnosis, seven years ago the standardization of management had already been established; in this case we encountered a type 1 Amyand's Hernia so we performed a standard tension free hernioplasty without complications. CONCLUSION: Amyand hernia is a rare condition, which represents two of the most common diseases a general surgeon has to face. Standardization of treatment is still ongoing and more prospective studies need to be done. This case demonstrates that this pathology must remain in the mind of the surgeons especially in the event of a strangulated hernia and offer a comprehensive review.

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(AU)

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(AU)

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.