EP58 - Gangrenous appendicitis in an incarcerated femoral hernia: A rare case of De Garengeot Hernia

Abstract Aims To present a rare case of gangrenous appendicitis within an incarcerated femoral hernia, discussing its clinical background and highlighting the challenges in its diagnosis and surgical management. Methods We detail a 74-year-old female with a painful, non-reducible groin mass. A CT abdomen pelvis revealed a right femoral hernia with acute reactive inflammatory changes, with no comment made on the appendix (Figure 1 and 2). Emergency open femoral hernioplasty and laparoscopic appendectomy were performed. Results Intraoperatively, a femoral hernia with a gangrenous appendicitis were identified. The appendix was reduced into the abdominal cavity to allow for better evaluation of its base. A laparoscopic appendectomy was performed after identifying the healthy base (Figure 3), followed by a femoral hernioplasty. This case sheds light on the rarity not only of the De Garengeot hernia which is defined by the presence of the vermiform appendix within the femoral hernia sac, but also even rarer the finding of a gangrenous appendix within the sac, with a reported incidence from 0.08-0.13% in cases of acute appendicitis. The case emphasizes the importance of considering an acute appendicitis and its complications within a femoral hernia as a differential diagnosis of painful groin masses with raised inflammatory markers. Conclusion Given the scarcity of literature on the surgical management of acute appendicitis in De Garengeot hernias, this case contributes valuable insights. The absence of established guidelines underscores the need for further exploration of optimal surgical strategies in such cases. Our report aims to enhance awareness of this rare presentation and facilitate future discussions on its management.