Incarcerated De Garengeot Hernia: An Atypical Presentation of an Abdominal Emergency: A Case Report

Incarcerated De Garengeot Hernia

Abstract

De Garengeot hernia is an uncommon form of femoral hernia in which the vermiform appendix is located within the hernia sac. Because its clinical presentation is usually nonspecific, the diagnosis is often difficult before surgery. An 87-year-old woman was evaluated for a painful right groin mass that had been present for one month and had worsened during the preceding two days. Ultrasonography suggested incarcerated hernia contents, and contrast-enhanced abdominopelvic computed tomography identified the distal appendix within the right femoral canal. Emergency surgery was performed through an anterior open approach. An incarcerated femoral hernia containing the appendix and hemorrhagic fluid was found, with ischemic-appearing changes in the distal third of the appendix. Appendectomy and tissue-based femoral hernia repair using the McVay technique were performed without mesh because of the potentially contaminated operative field. Histopathology showed recent transmural hemorrhage without acute appendicitis, supporting incarceration-related vascular compromise rather than primary inflammatory appendicitis. The patient had an uncomplicated postoperative course and was discharged 24 hours after surgery. This case emphasizes the value of preoperative imaging in selected patients and supports tailoring surgical management according to intraoperative findings.