Abstract
Background
A De Garengeot hernia is a femoral hernia that contains the appendix. This rare type of hernia was first described by René-Jacques Croissant De Garengeot in 1731. Numerous case reports have been published since then, yet collective analysis about the presentation, diagnosis, management, and outcomes of patients with this unique hernia is lacking.
Methods
A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science for cases of De Garengeot hernias. Keywords searched included "De Garengeot hernia” OR “femoral appendicitis” OR “femoral hernia appendix” OR “crural hernia appendix.” To facilitate review, a classification system was created based on the gross appearance of the appendix and related structures in the femoral hernia.
Results
Two hundred and twenty-two cases were identified in 197 manuscripts. Cases most commonly came from Europe but have been reported worldwide. There was a female predominance (n = 180, 81.1%) and the mean age at presentation was 69.8 years. The most common presenting symptoms were a groin bulge and groin tenderness (82.4%, n = 183 and 79.7%, n = 177, respectively). A groin bulge was observed on physical exam in 95.0% (n = 211) of cases, and erythema over the hernia was present in 33.3% (n = 74). A pre-operative diagnosis of a De Garengeot hernia was established with imaging in only 31.5% (n = 70) of cases. The most common surgical approach was through a groin incision. Complications occurred in 9.5% (n = 21) of cases, most commonly surgical site infections. The most common condition of the appendix was congested/inflamed, found in 44.1% (n = 98) of cases and corresponding to class 2A in the classification system devised.
Conclusions
Overall, De Garengeot hernias were found to be rare and clinically heterogeneous, as highlighted by our classification system. A systematic approach to categorizing this unique hernia may improve management decisions and help avoid complications.
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References
De Garengeot RJC (1731) Traité des operations de chirurgie 1edn
Amyand C (1735) VIII. Of an inguinal rupture, with a pin in the appendix coeci, incrusted with stone; and some observations on wounds in the guts. Philos Trans 39:329–342
Hévin P, Simon J-F (1793) Cours de pathologie et de thérapeutique chirurgicales, chez Méquignon l'aîné
Akopian G, Alexander M (2005) De Garengeot hernia: Appendicitis within a femoral hernia. Am Surg 71:526–527
Carey LC (1967) Acute appendicitis occurring in hernias: a report of 10 cases. Surgery 61:236–238
Watkins RM (1981) Appendix abscess in a femoral hernial sac: case report and review of the literature. Postgrad Med J 57:306
Hayakawa E, Hackett T (2015) Incidental finding of incarcerated De Garengeot hernia during laparoscopic cholecystectomy. Case Stud Surg 1:26
Sharma H, Jha P, Shekhawat N, Memon B, Memon M (2007) De Garengeot hernia: an analysis of our experience. Hernia 11:235
Priego P, Lobo E, Moreno I, Sánchez-Picot S, Olarte MAG, Alonso N, Fresneda V (2005) Acute appendicitis in an incarcerated crural hernia: analysis of our experience Apendicitis aguda en una hernia crural incarcerada: análisis de nuestra experiencia. Rev Esp Enferm Dig 97:707–715
Wise L, Tanner N (1963) Strangulated Femoral Hernia appendix with perforated sigmoid diverticulitis. Proc R Soc Med 56:1105–1106
Ryan WJ (1937) Brief communications and case reports. Ann Surg 106:135–146
Wood AC (1906) IV Appendicular Femoral Hernia, with notes of 100 cases. Ann Surg 43:668
Watson LS (1924) Hernia, its anatomy, etiology, symptoms, diagnosis, differential diagnosis, prognosis, and operative treatment. Kimpton, London
Garcia-Amador C, De La Plaza R, Arteaga V, Lopez-Marcano A, Ramia J (2016) Garengeot's Hernia: two case reports with CT diagnosis and literature review. Open Med 11:343–349
Kalles V, Mekras A, Mekras D, Papapanagiotou I, Al-Harethee W, Sotiropoulos G, Liakou P, Kastania A, Piperos T, Mariolis-Sapsakos T (2013) De Garengeot’s hernia: a comprehensive review. Hernia 17:177–182
Evangelos PM, Anna P, Anastasia P, Nikolaos M, Vasileia D, Nikolaos K, Theodore K, Nick Z, Anastasios M (2018) De Garengeot’s Hernia: report of a rare surgical emergency and review of the literature. Front Surg 5:12
Linder S, Linder G, Månsson C (2019) Treatment of de Garengeot's hernia: a meta-analysis. Hernia 23:131–141
Ryan JW, Riordan I, Gorey T, Geoghegan T (2017) de Garengeot hernia with a mucinous neoplasm of the appendix, two clinical rarities combine to yield a first for the literature. BMJ Case Rep. https://doi.org/10.1136/bcr-2017-220830
Yeh D, Abeysinghe J (2014) Rare case of a de Garengeot’s hernia. Eur J Surg Sci 5:77–80
Suppiah A, Barandiaran J, Morgan R, Perry E (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 12:95–98
Nayak IN (1974) Malignant mucocele of the appendix in a femoral hernia. Postgrad Med J 50:246
Spencer RF, Livingstone PD (1984) Unusual combined pathology in a femoral hernia. J R Coll Surg Edinb 29:255
Hachisuka T (2003) Femoral hernia repair. Surg Clin N Am 83:1189–1205
Jin Z, Imtiaz MR, Nnajiuba H, Samlalsingh S, Ojo A (2016) De Garengeot’s hernia: two case reports with correct preoperative identification of the vermiform appendix in the hernia. Case Rep Surg 2016:2424657
Voitk JA, Macfarlane KJ, Estrada LR (1974) Ruptured appendicitis in femoral hernias: report of two cases and review of the literature. Ann Surg 179:24–26
Fukukura Y, Chang S (2005) Acute appendicitis within a femoral hernia: multidetector CT findings. Abdom Imaging 30:620–622
Grgić T, Šuvak I (2011) De Garengeot hernia- case report. Acta Chirurg 8:17–19
Cutolo CL, Wasserman LI, Pinck AR, Mainzer AR (1978) Acute suppurative appendicitis occurring within a femoral hernia: report of a case. Dis Colon Rectum 21:203–204
Rose RH, Cosgrove JM (1988) Perforated appendix in the incarcerated femoral hernia. A place for preperitoneal repair. N Y State J Med 88:600
Mikkelsen T, Bay-Nielsen M, Kehlet H (2002) Risk of femoral hernia after inguinal herniorrhaphy. Br J Surg 89:486–488
Connor SJ, Hanna GB, Frizelle FA (1998) Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies. Dis Colon Rectum 41:75–80
Mun S, Ernst RD, Chen K, Oto A, Shah S, Mileski WJ (2006) Rapid CT diagnosis of acute appendicitis with IV contrast material. Emerg Radiol 12:99–102
Doddi S, Sagar V, Singhal T, Balakrishnan S, Smedley F, Sinha P (2010) Femoral hernia with a twist. Case Rep Med 2010:650829
Takemura M, Iwamoto K, Goshi S, Osugi H, Kinoshita H (2000) Strangulated femoral hernia containing gangrenous appendicitis: report of a case. Nihon Gekakei Rengo Gakkaishi 25:789–791
Caygill P, Nair R, Sajjanshetty M, Francis D (2011) An unusual groin exploration: De Garengeot's hernia. Int J Surg Case Rep 2:74–75
Kagan Coskun A, Kilbas Z, Yigit T, Simsek A, Harlak A (2012) De Garengeot's hernia: the importance of early diagnosis and its complications. Hernia 16:731–733
Hao J, Yao J, Guo D, Sun W, Liang J, Jiang X (2014) De Garengeot hernia: the ultrasound and computed tomographic findings in an 81-year-old woman. Am J Emerg Med 32:486.e485–e486
Barbaros U, Asoglu O, Seven R, Kalayci M (2004) Appendicitis in incarcerated femoral hernia. Hernia 8:281–282
Losanoff JE, Basson MD (2007) Amyand hernia: what lies beneath—a proposed classification scheme to determine management. Am Surg 73:1288–1290
Comman A, Gaetzschmann P, Hanner T, Behrend M (2007) DeGarengeot hernia: transabdominal preperitoneal hernia repair and appendectomy. JSLS 11:496–501
Beysens M, Haeck L, Vindevoghel K (2013) Laparoscopic appendectomy combined with TEP for de Garengeot hernia: case report. Acta Chirurg 113:468–470
Biondi A, Di Stefano C, Ferrara F, Bellia A, Vacante M, Piazza L (2016) Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg 11:44
Wen SW, Hernandez R, Naylor CD (1995) Pitfalls in nonrandomized outcomes studies: the case of incidental appendectomy with open cholecystectomy. JAMA 274:1687–1691
Cordera F, Sarr M (2003) Incarcerated appendix in a femoral hernia sac. Contemp Surg 59:35–37
Sinraj AP, Anekal N, Rathnakar SK (2016) De Garengeot’s hernia – A diagnostic and therapeutic challenge. J Clin Diagn Res 10:PD19–PD20
Nakamura T, Igarashi H, Ito T, Jensen RT (2014) Important of case-reports/series, in rare diseases: using neuroendocrine tumors as an example. World J Clin Cases 2:608
Funding
The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR001860 for author CMT.
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The views expressed in this material are those of the authors and do not reflect the official policy or opinion of the U.S. Government, Department of Veteran Affairs, the Department of Defense, or the Department of the Air Force. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Drs Guenther, Theodorou, Grace, Rinderknecht, and Wiedeman have no conflicts of interest or financial ties to disclose.
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Guenther, T.M., Theodorou, C.M., Grace, N.L. et al. De Garengeot hernia: a systematic review. Surg Endosc 35, 503–513 (2021). https://doi.org/10.1007/s00464-020-07934-5
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DOI: https://doi.org/10.1007/s00464-020-07934-5