Subacute Appendicitis Within a De Garengeot Hernia: A Rare Case and Management Considerations

Introduction: De Garengeot hernias are a rare type of femoral hernia which contains the appendix inside the hernia sac. Prompt surgical intervention is required when appendicitis develops within the hernia. Diagnosis and management are often challenging due to the uncommon nature of this condition. Case Presentation: We report the case of a 61-year-old female who presented to the clinic with right lower quadrant pain and an erythematous bulge in the right groin. A CT scan confirmed the presence of a femoral hernia with an incarcerated appendicitis. She was managed by the general surgery team and underwent a staged appendectomy followed by femoral hernia repair via an open anterior approach. The patient recovered uneventfully. Discussion: De Garengeot hernia is a rare clinical entity which is often misdiagnosed preoperatively. The decision to treat in a one- or two-stage fashion, as well as open or laparoscopically, is nuanced and requires consideration of contamination within the femoral space and if mesh is required for hernia repair. CT imaging can aid in diagnosis but has a relatively low sensitivity and specificity. Prompt recognition and surgical management are critical for preventing complications. Conclusion: De Garengeot hernia is a rare but serious surgical condition requiring prompt intervention for optimal outcomes.