WTP2.15 Inflammation of appendix in a De Garengeot hernia, managed by combined laparoscopic and open approach

Abstract Introduction Femoral hernia constitutes less than 3% of all hernias with rate of incarceration between 5-20%. Protrusion of appendix in femoral hernia is called De Garengeot hernia. Its incidence is .1 to 5% of femoral hernias and 0.13% to 1% of all cases of acute appendicitis. Case presentation A 78-year-old male presented in emergency department with one-day history of pain in the right groin. He was hemodynamically stable, examination findings was an irreducible right groin hernia with no clinical features of obstruction or strangulation. Investigations Serology was unremarkable. CT imaging of the abdomen and pelvis reported a right-sided femoral hernia which contained the tip of the appendix with some fluid. The tip of the appendix was thickened with peri-appendiceal fat stranding. There were no features of perforation. Treatment The patient underwent laparoscopic appendectomy followed by mesh plug of right femoral hernia with lockwood approach. Outcome The patient had an uneventful recovery and he was subsequently discharged the following day. Conclusion De Garengeot hernia is a rare type of hernia. Preoperative diagnosis is the key to surgical planning. Various surgical methods can be used which are deemed acceptable. De Garengeot hernia must be considered as a differential in patients presenting with groin swelling.