Abstract
Purpose
Acute appendicitis within a femoral hernia is a rare condition that was first described by Rene Jacques de Garengeot. In the present study, we summarize the existing evidence on de Garengeot’s hernia, with special emphasis on its clinical presentation and diagnostic approach.
Methods
A thorough search of the English-language literature published between 1980 and 2011 was performed. Studies reporting cases of de Garengeot’s hernia were selected using specific inclusion criteria (description of femoral hernia appendicitis, statement of patient demographics and symptoms, and statement of diagnostic tests performed).
Results
Thirty-one studies that encompassed 36 patients (28 women, mean age 71.5 years) with de Garengeot’s hernia were included in our analysis. Patients presented with a right groin mass in 35 (97 %) cases. The mass was almost always painful (n = 35, 97 %), while 14 (39 %) of the patients were febrile. Mean duration of symptoms was 5.17 days. Fifty-six percent of the groin masses were erythematous. Leukocytosis was present in 67 % of the patients, and 25 patients underwent imaging investigation with X-ray (n = 11), Ultrasound (n = 5) or Computed Tomography (CT, n = 9). Twenty percent of the Ultrasound and 44 % of the CT studies were diagnostic, leading to an overall rate of 14 % of femoral hernia appendicitis preoperative diagnosis. Eighty-one percent of the patients underwent herniorrhaphy with sutures while a mesh was used in 19 %. Mean hospital stay was 6.23 days.
Conclusion
Preoperative diagnosis of de Garengeot’s hernia is difficult due to its atypical clinical presentation. Further surgical treatment depends on the surgeon’s sound clinical judgment.
Similar content being viewed by others
References
De Garengeot RJC (1731) Traité des operations de chirurgie. Huart, Paris
Akopian G, Alexander M (2005) De Garengeot hernia: appendicitis within a femoral hernia. Am Surg 71(6):526–527
Kia-Nouri M (1962) Isolated incarcerated appendix in a femoral hernia. Review of the literature and report of a case. J Albert Einstein Med Cent (Phila) 10:38–39
Piperos T, Kalles V, Al Awhal Y, Konstantinou E, Skarpas G, Mariolis-Sapsakos T (2012) Clinical significance of de Garengeot’s hernia: a case of acute appendicitis and review of the literature. Int J Surg Case Rep 3(3):116–117
Shum J (2012) Management of appendicitis in a femoral hernia. Int J Surg Case Rep 3(1):10–11
Caygill P, Nair R, Sajjanshetty M, Francis D (2011) An unusual groin exploration: de Garengeot’s hernia. Int J Surg Case Rep 2(5):74–75
Konofaos P, Spartalis E, Smirnis A, Kontzoglou K, Kouraklis G (2011) De Garengeot’s hernia in a 60-year-old woman: a case report. J Med Case Rep 5(1):258
Georgiou GK, Bali C, Theodorou SJ, Zioga A, Fatouros M Appendiceal diverticulitis in a femoral hernia causing necrotizing fasciitis of the right inguinal region: report of a unique case. Hernia. doi:10.1007/s10029-011-0822-0
Phillips AW, Aspinall SR Appendicitis and Meckel’s diverticulum in a femoral hernia: simultaneous De Garengeot and Littre’s hernia. Hernia. doi:10.1007/s10029-011-0812-2
Kagan Coskun A, Kilbas Z, Yigit T, Simsek A, Harlak A De Garengeot’s hernia: the importance of early diagnosis and its complications. Hernia. doi:10.1007/s10029-011-0814-0
Rebai W, Hentati H, Makni A, Ksontini R, Chebbi F, Ftiriche F, Jouini M, Kacem M, Ben Safta Z (2010) Appendicitis in strangulated femoral hernia: a case report. Tunis Med 88(3):193–195
Ebisawa K, Yamazaki S, Kimura Y, Kashio M, Kurito K, Yasumuro S, Nishida S, Takayama T (2009) Acute appendicitis in an incarcerated femoral hernia: a case of de Garengeot hernia. Case Rep Gastroenterol 3(3):313–317
Rajan SS, Girn HR, Ainslie WG (2009) Inflamed appendix in a femoral hernial sac: de Garengeot’s hernia. Hernia 13(5):551–553
Chung A, Goel A (2009) Images in clinical medicine. De Garengeot’s hernia. N Engl J Med 361(11):e18
Thomas B, Thomas M, McVay B, Chivate J (2009) De Garengeot hernia. JSLS 13(3):455–457
Pitchaimuthu M, Dace S (2009) A rare presentation of appendicitis as groin swelling: a case report. Cases J 2(1):53
Suppiah A, Barandiaran J, Morgan R, Perry EP (2008) First case of villous adenoma of the appendix leading to acute appendicitis presenting as strangulated femoral hernia: changes in management owing to concurrent adenoma. Hernia 12(1):95–98
Wiszniewski M, Faflik M, Grabowski M (2008) Femoral hernia with acute appendicitis in a male patient. Wiad Lek 61(1–3):85–87
Comman A, Gaetzschmann P, Hanner T, Behrend M (2007) DeGarengeot hernia: transabdominal preperitoneal hernia repair and appendectomy. JSLS 11(4):496–501
Maizlin ZV, Mason AC, Brown C, Brown JA (2007) CT findings of normal and inflamed appendix in groin hernia. Emerg Radiol 14(2):97–100
Filatov J, Ilibitzki A, Davidovitch S, Soudack M (2006) Appendicitis within a femoral hernia: sonographic appearance. J Ultrasound Med 25(9):1233–1235
D’Ambrosio N, Katz D, Hines J (2006) Perforated appendix within a femoral hernia. AJR Am J Roentgenol 186(3):906–907
Fukukura Y, Chang SD (2005) Acute appendicitis within a femoral hernia: multidetector CT findings. Abdom Imaging 30(5):620–622
Fitzgerald E, Neary P, Conlon KC (2005) An unusual case of appendicitis. Ir J Med Sci 174(1):65–66
Barbaros U, Asoglu O, Seven R, Kalayci M (2004) Appendicitis in incarcerated femoral hernia. Hernia 8(3):281–282
Nguyen ET, Komenaka IK (2004) Strangulated femoral hernia containing a perforated appendix. Can J Surg 47(1):68–69
Isaacs LE, Felsenstein CH (2002) Acute appendicitis in a femoral hernia: an unusual presentation of a groin mass. J Emerg Med 23(1):15–18
Zissin R, Brautbar O, Shapiro-Feinberg M (2000) CT diagnosis of acute appendicitis in a femoral hernia. Br J Radiol 73(873):1013–1014
Guirguis EM, Taylor GA, Chadwick CD (1989) Femoral appendicitis: an unusual case. Can J Surg 32(5):380–381
Rose RH, Cosgrove JM (1988) Perforated appendix in the incarcerated femoral hernia. A place for preperitoneal repair. NY State J Med 88(11):600–602
Khatib CM (1987) Strangulated femoral hernia containing acute gangrenous appendicitis: case report and review of the literature. Can J Surg 30(1):50
Thomas WE, Vowles KD, Williamson RC (1982) Appendicitis in external herniae. Ann R Coll Surg Engl 64(2):121–122
Watkins RM (1981) Appendix abscess in a femoral hernial sac—case report and review of the literature. Postgrad Med J 57(667):306–307
Tanner N (1963) Strangulated femoral hernia appendix with perforated sigmoid diverticulitis. Proc R Soc Med 56:1105–1106
Gurer A, Ozdogan M, Ozlem N, Yildirim A, Kulacoglu H, Aydin R (2006) Uncommon content in groin hernia sac. Hernia 10(2):152–155
Wyatt JP, Varma JS (1992) Femoral hernia appendix causing small intestinal obstruction. Postgrad Med J 68(797):223–224
Burgess PL, Brockmeyer JR, Johnson EK (2011) Amyand hernia repaired with Bio-A: a case report and review. J Surg Educ 68(1):62–66
Armstrong O (2010) Appendix strangulated in a femoral hernia. Hernia 14(2):225–226
Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338(3):141–146
Voitk AJ, MacFarlane JK, Estrada RL (1974) Ruptured appendicitis in femoral hernias: report of two cases and review of the literature. Ann Surg 179(1):24–26
Rucinski J, Fabian T, Panagopoulos G, Schein M, Wise L (2000) Gangrenous and perforated appendicitis: a meta-analytic study of 2532 patients indicates that the incision should be closed primarily. Surgery 127(2):136–141
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kalles, V., Mekras, A., Mekras, D. et al. De Garengeot’s hernia: a comprehensive review. Hernia 17, 177–182 (2013). https://doi.org/10.1007/s10029-012-0993-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-012-0993-3