A De Garengeot hernia is a rare type of femoral hernia that involves a vermiform appendix within a femoral hernia sac. Because of the rarity of this disease, a standard surgical procedure has not been established, and most cases are diagnosed intraoperatively. Preoperative diagnosis of a De Garengeot hernia is quite difficult. Computed tomography is the most sensitive and specific technique among the available imaging tests for preoperative diagnosis of a De Garengeot hernia. Although a standard surgical procedure is lacking, prompt surgery has become the consensus. The most common procedure is the open anterior approach; this allows exploration of the hernia sac and rapid treatment of its contents, routine appendectomy through a single incision, and preperitoneal repair of the femoral hernia.

BACKGROUND: De Garengeot\'s hernia is a rare type of femoral hernia which describes the vermiform appendix incarcerated within the hernia sac. In this case report we present our case and review the surgical approaches described in the literature.
METHODS: We present the case of an 84-year-old female with a background of Parkinson\'s Disease who presented to the emergency department with a five day history of a right-sided groin lump with worsening pain, nausea and reduced appetite. Computed tomography of the abdomen and pelvis revealed an inflamed appendix herniating through the right femoral canal. She had a two staged surgical approach involving an open repair of her femoral hernia followed by laparoscopic appendicectomy.
CONCLUSIONS: Due to its rarity, there is no standard surgical approach to the appendicectomy and femoral hernia repair. Multiple approaches have been described in the literature, however most reports describe a simultaneous femoral hernia repair and appendicectomy. If an additional abdominal incision is required to complete the appendicectomy safely, we advocate the consideration of a hybrid open-laparoscopic approach, particularly in patients such as this with a history of Parkinson\'s disease.
CONCLUSIONS: Here we highlight the usefulness of combining an open low inguinal approach followed by a laparoscopic appendicectomy.

We present a rare case of De Garengeot hernia treated with simultaneous laparoscopic appendectomy and transabdominal preperitoneal hernia repair. Our patient was an 85-year-old man with a bulging mass in the right groin. De Garengeot hernia was observed on contrast-enhanced CT. Urgent laparoscopy showed the distal part of the appendix passing through a right-sided femoral hernia. Laparoscopic appendectomy was performed, followed by transabdominal preperitoneal repair of the femoral hernia. Pathological examination revealed ischemic necrosis of the appendix. The patient\'s postoperative recovery was uneventful.

BACKGROUND: De Garengeot\'s hernia is rare and describes a femoral hernia containing the vermiform appendix. Pre-operative diagnosis is at times difficult and operative intervention can prove challenging.
METHODS: We report a case of a 75-year-old woman with a swelling to the right groin for over 10 years which increased in size and became intermittently painful over a period of two weeks. Patient stated that an earlier consult was not sought as she had concerns about having to stay in hospital with the ongoing global pandemic and her significant cardiac history. Ultrasound and contrast enhanced Computed Tomography (CT) revealed typical radiological features of an inflamed appendix herniating through the femoral canal.
CONCLUSIONS: Due to its rarity a preoperative diagnosis of a de Garengeot hernia may be difficult. There is currently no consensus to surgical approach in this setting, management is widely varied and based on the preference and expertise available during these emergency procedures.
CONCLUSIONS: The de Garengeot hernia though uncommon should be recognised as a differential when faced with an incarcerated femoral hernia. To the best of our knowledge, this is the first case that combines ultrasound, CT findings and a preperitoneal surgical intervention.

BACKGROUND: 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 as cited by the literature.
METHODS: A 64-year-old female presented to the Emergency Department of our hospital with acute onset of a right-sided groin bulge that occurred earlier that day after doing heavy lifting. Her workup revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the appendiceal tip was incarcerated within the hernia sac. It was removed through the open inguinal incision after the appendix base was divided laparoscopically. Final pathology showed inflamed acute appendicitis without evidence for neoplasm.
CONCLUSIONS: Physicians should be aware of the rare entity of an unusual presentation of appendicitis as well as surgical options for treatment. The literature does not conclude upon a gold standard for method of approach.
CONCLUSIONS: De Garengeot hernia remains a rare and unusual surgical presentation of femoral hernia, and complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach which should be individualized to each patient.

De Garengeot\'s hernia is a rare clinical entity. Appropriate and acute diagnosis in emergency basis is challenging (usually misdiagnosed as incarcerated femoral hernia), and the surgical management varies from case to case. This report emphasizes the importance of including De Garengeot\'s hernia in the differential diagnosis of incarcerated groin hernias and the need to establish a well-defined strategy regarding surgical management options.

We present a case of a 78-year-old female patient with an uncommon presentation of acute appendicitis. She was found to have a perforated appendicitis which developed in a femoral hernia sack. An appendix present in a femoral hernia is called a De Garengeot Hernia, which is a rare form of femoral hernia. Clinical presentation, diagnosis and management are discussed.

BACKGROUND: De Garengeot hernia is a rare type of femoral hernia, defined as a sac containing a vermiform appendix. Due to its rare occurrence the information available on diagnosis and management is scarce. We report the use of a recently described technique for femoral hernia repair and appendicectomy.
METHODS: A 67 year old female presented to the emergency department with features of incarcerated femoral hernia. CT imaging revealed an incarcerated appendix within a femoral hernia. The patient subsequently underwent surgery, where the femoral hernia was repaired and appendicectomy performed concurrently.
CONCLUSIONS: Clinical diagnosis is difficult, and there have only been a few documented cases of pre-operative CT diagnoses in the literature. The usual risk factors for developing a hernia would apply to this pathology, and other anatomical and embryological considerations are explored. The King\'s College technique for femoral hernia repair involves an incision that allows repair of the hernia and also the ability to enter the peritoneal cavity using the same incision. This approach was used in this case, where the abdominal cavity had to be entered to perform the appendicectomy, before the femoral hernia could be repaired.
CONCLUSIONS: Pre-operative diagnosis of De Garengeot hernia is difficult, as it may mimic an incarcerated femoral hernia containing other contents. The diagnosis becomes apparent intra-operatively. The clinical significance lies in that intra-abdominal access may be required to safely perform an appendicectomy before the repair of the hernia defect, and this article includes a description of a suitable technique for this particular pathology.

BACKGROUND: A De Garengeot\'s hernia is the very rare dual pathology of a vermiform appendix within a femoral hernia.
METHODS: We discuss the rare case of a 62 year old female who presented as an emergency with a strangulated femoral hernia. Within the hernia sac a partly necrotic vermiform appendix was discovered. The patient successfully underwent an appendicectomy and repair of her femoral hernia. The post-operative period was uneventful, with no further issues at follow-up.
CONCLUSIONS: Our case report displays the successful treatment of a De Garengeot\'s hernia as an emergency admission, with a shorter than average admission time, and no post-operative complications.
CONCLUSIONS: This is a rare case of dual pathology, of which we believe there are few published cases.

BACKGROUND: Femoral hernias may - in some rare cases - contain the appendix, a phenomenon called de Garengeot hernia. It is usually an incidental finding in hernia repair. We found our case to be of interest because of the long standing femoral swelling before peracute appendicitis led to its removal.
METHODS: We present the case of a 71-year-old woman with a swelling of the right medial thigh for over more than 30 years. When the swelling suddenly grew in size and became tender, she was referred to our emergency department. Sonographically as well as clinically a femoral hernia was diagnosed. Intraoperatively, the appendix was found and open appendectomy as well as a hernioplasty was performed.
CONCLUSIONS: Open appendectomy is an elegant and safe procedure to repair a long standing de Garengeot hernia. Most case reports call for extensive diagnostics such as CT scan etc. We found a sonography of the femoral region to be conclusive.
CONCLUSIONS: Apart from the inherent risk of sudden incarceration in hernias, De Garengeot hernias can also develop peracute appendicitis years after their formation. This differential diagnosis needs to be taken into consideration in patients presenting with the clinical signs of a femoral hernia.