De Garengeot hernias are femoral hernias that contain the appendix. It is a rare phenomenon, with only 1% of all femoral hernias containing the appendix (and. De Garengeot hernia should be suspected in an elderly woman presenting with signs and symptoms of a strangulated hernia. The differential. Images in Clinical Medicine from The New England Journal of Medicine — De Garengeot’s Hernia.
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This type of hernia usually presents with therapeutic dilemmas, especially because of the risk of surgical site infection SSI.
Our patient was a year-old woman with a bulging garenteot and tenderness in the right inguinal area. Computed tomography revealed an incarcerated appendix, with appendicitis in the femoral hernia. Laparoscopic appendectomy was initially performed, followed by hernioplasty via the anterior approach to prevent properitoneal contamination.
Some authors have recently reported cases successfully treated by laparoscopy.
However, this type of hernia has a higher risk for SSI, compared with the risk involved garengeog usual hernioplasty. Therefore, selection of the appropriate surgical approach to prevent wound infection is important, especially in the presence of appendicitis.
We would like to highlight the usefulness of hybrid surgery, laparoscopic appendectomy and hernioplasty via the anterior approach to prevent SSIs. This rare condition occurs in 0.
The presence of acute appendicitis within a de Garengeot hernia is rarer, with an incidence of 0. To our knowledge, fewer than cases of de Garengeot hernia have been reported, and no standard surgical approach has been described for this condition.
We recently found some cases that were successfully treated using the laparoscopic approach, in the literature. However, the treatment for this condition along with acute appendicitis is still controversial. We present a case of a patient with de Garengeot hernia with appendicitis who was successfully treated by performing a hybrid surgery, laparoscopic appendectomy, and anterior hernioplasty.
A year-old woman with aplastic anaemia and hypertension who complained of a bulging mass and tenderness in the right hernka area was referred to our department. She was afebrile, normotensive, and denied abdominal pain, bloating, nausea or vomiting. The swelling was irreducible but not strangulated.
De Garengeot hernia: Case report and review
Laboratory examination findings showed that the white blood cell count and C-reactive protein level of the patient were within the normal range, but the percentage of neutrophilic leucocytes was slightly increased, at Abdominal enhanced computed tomography CT revealed a swelling and an enhanced appendix within the femoral hernia Fig. Hence, a diagnosis of de Garengeot hernia with suspected acute appendicitis was made, and surgery was performed. No ascites or dilated bowels were observed.
The major part of the appendix passed through the femoral orifice Fig. Then, two additional 5-mm trocars were inserted in the left lower and middle abdominal regions. The hernia could be reduced by deliberately pulling the appendix.
A necrotic and inflamed appendix was detected Fig. Subsequently, laparoscopic appendectomy was performed. Hernioplasty was performed via the anterior approach to prevent properitoneal contamination. The hernial defect was repaired using a mesh plug. The incarcerated hernia sac was reduced via the extraperitoneum, and it was then ligated and resected via laparoscopy Fig. The pathological findings showed acute purulent appendicitis.
The postoperative course of the patient was uneventful, without any surgical site infection SSIand she was discharged on the postoperative Day 8.
Abdominal enhanced computed tomography imaging showing a the enhanced tubular structure in the femoral hernia and b the caecum. It is a rare condition that presents with a swelling mass in the groin, which is often tender. Femoral hernia is more common in women, especially in postmenopausal women.
Thus, early surgery is often required. Some theories have proposed the pathogenesis of the migration of the appendix into the femoral hernia. One theory is abnormal intestinal rotation during embryological development, and appendiceal attachment is another theory. A mobile caecum, large caecum or visceroptosis is also considered a risk factor for de Garengeot hernia [ 14 ]. In our patient, the caecum was fixed at a lower position. The preoperative diagnosis of de Garengeot hernia was known to be difficult.
However, a preoperative diagnosis has often been reported in recent studies, mostly through CT [ 5 ].
CT demonstrates a tubular structure following the caecum in the femoral hernia. Surgical management of de Garengeot hernia is controversial.
De Garengeot Hernia
Several surgical approaches exist, including open or laparoscopic approaches either with or without appendectomy, with mesh or simple suture hernioplasty. We found some recent reports on cases in which the patients were successfully treated using the laparoscopic approach [ 6 ].
Some authors reported that transabdominal preperitoneal hernioplasty had the benefit of diagnostic laparoscopy, and they could concurrently perform appendectomy. However, in patients with appendicitis, the risk of mesh infection should be prevented. The rate of SSI for inguinal and femoral hernia repairs is 0. Moreover, the rates of SSI are 6. In agrengeot case, laparoscopic findings revealed an inflamed and necrotic appendix. We performed appendectomy and hernioplasty via different approaches to prevent mesh contamination.
Some authors recommended a simple suture repair in appendectomy [ 10 ]. Although some authors have reported successful mesh repairs per infra-inguinal incision performed in the presence of appendicitis, we insist that the surgical site of hernioplasty should not be contaminated.
Thus, we recommend different incision approaches, as applied in our case, or interval hernioplasty, especially in patients with concurrent appendicitis. Hybrid surgery, laparoscopic appendectomy and hernioplasty via the anterior approach are recommended in hhernia with de Garengeot hernia with appendicitis. Using a different approach for each surgery could help prevent contamination of the surgical site.
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Abstract de Garengeot hernia is a rare subtype of a femoral hernia with incarceration of the appendix. View large Download slide. Laparoscopic findings showing migration of the appendix into the femoral hernia.
Stratification of surgical site infection by operative factors and comparison hefnia infection rates after hernia repair. For commercial re-use, please contact journals. Email alerts New issue alert. In progress issue alert.
De Garengeot Hernia
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