The rare case of De Garengeot hernia: femoral hernia containing perforated appendicitis

Femoral hernias account for similar to 4% of all groin hernias but are much more common in females, especially those over the age of 70. Risk of incarceration is overall low but can include structures such as bowel, omentum, bladder, ovary and very rarely, the appendix. The subset of femoral hernias containing the vermiform appendix is known as de Garengeot hernias. We describe a rare case of an 87-year-old female patient who presented with an incarcerated right femoral hernia confirmed on contrast-enhanced computed tomography scan of the abdomen and pelvis, with subsequent open hernia reduction revealing a perforated necrotic appendix with pus contained in the hernia sac. Histopathology revealed acute appendicitis with increased stromal fibrosis suggestive of a chronic process. Pre-operative diagnosis of de Garengeot hernias remains challenging due to their non-specific presentation and attenuated clinical symptoms, and most diagnoses are made intraoperatively.