De Garengoet`s hernia is a femoral hernia containing the appendix. Awareness of this hernia is essential to prevent misdiagnosis and wrong choice of an operative procedure. The status of appendix dictates the choice of approach and nature of repair for the hernia. The pathophysiology, diagnosis and management of De Garengoet`s hernia is presented in this article to create an awareness of this rare hernia

1. International Surgery Journal | April-June 2016 | Vol 3 | Issue 2 Page 471
International Surgery Journal
Vagholkar K et al. Int Surg J. 2016 May;3(2):471-472
http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902
Review Article
De Garengeot’s hernia: a surgical surprise
Ketan Vagholkar*, Amish Pawanarkar, Suvarna Vagholkar, Kashmoorvalishah Pathan,
Shamshershah Pathan
INTRODUCTION
The vermiform appendix though described as a vestigial
organ in humans can cause a wide range of surgical
diseases.
When the appendix occupies the space within the hernia
sac in the groin it poses both a diagnostic and surgical
challenge to the attending surgeon. Femoral hernia by
itself is quite an uncommon entity seen predominately in
the female population. A complicated femoral hernia
containing the appendix can pose a serious challenge to
both the diagnostic and surgical skills of the surgeon.
Rene Jacques Croissant de Garengeot was first to
describe the presence of the appendix in a femoral
hernia.1
The pathophysiology, diagnosis and management
is discussed.
Pathophysiology
The appendix usually lies in right iliac fossa. The
presence of the appendix in a femoral hernia is an
enigmatic situation. Various theories have been
postulated to explain the aetiology.
Migration of the appendix into a femoral hernia is
possible by virtue of an abnormal anatomic position. It
may depend on abnormal intestinal rotation during early
development or be related to abnormality of the caecum.
Abnormal mobility of caecum by virtue of altered
attachments of the caecum can predispose to lower than
normal position of the caecum along with the appendix.3,4
Once the appendix finds its way into a femoral hernia, the
natural history of disease may follow a variable course.
The appendix usually gets inflamed in the hernia sac
giving rise to a typical picture of an incarcerated and
inflamed hernia. The aetiology of inflammation may
range from intraluminal obstruction by a faecolith or
hypertrophy of lymphatic tissue to inflammation caused
by ischemia due to strangulation by the narrow neck of
the femoral ring.5
Clinical features
The clinical features may range from vague abdominal
pain to severely painful and erythematous swelling in the
groin. In advanced presentations the patient may have
systemic symptoms such as fever accompanied with
abdominal signs of distension and tenderness in the lower
abdomen.
ABSTRACT
De Garengoet`s hernia is a femoral hernia containing the appendix. Awareness of this hernia is essential to prevent
misdiagnosis and wrong choice of an operative procedure. The status of appendix dictates the choice of approach and
nature of repair for the hernia. The pathophysiology, diagnosis and management of De Garengoet`s hernia is
presented in this article to create an awareness of this rare hernia.
Keywords: De Garengoet’s, Hernia, Pathophysiology, Management
Department of Surgery, D.Y. Patil University, School of Medicine, Navi Mumbai, India
Received: 14 April 2016
Accepted: 19 April 2016
*Correspondence:
Dr. Ketan Vagholkar,
E-mail: kvagholkar@yahoo.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2349-2902.isj20161120

2. Vagholkar K et al. Int Surg J. 2016 May;3(2):471-472
International Surgery Journal | April-June 2016 | Vol 3 | Issue 2 Page 472
The severity of such clinical features may depend on the
severity of the inflammatory process. It could either be
early inflammation or perforation leading to an abscess,
which could complicate the presentation.
Diagnosis
Haematological investigations will reveal neutrophilic
leukocytosis. A contrast enhanced CT of the abdomen
may help in identifying the contents of the femoral hernia
sac. However CT may not always be diagnostic in all
cases.6
The presence of a low position of the caecum with
an adjacent fluid filled tubular structure entering into the
hernia sac is typical of De Garengoet`s hernia.4
Sonographic findings may be confusing and may not
always be able to diagnose the condition. Therefore
majority of such cases are usually diagnosed
intraoperatively.
Surgical approach
The presence of the appendix in a femoral hernia sac
poses the biggest surgical dilemma. The status of the
appendix dictates the choice of therapeutic options.5,6
If the appendix is inflamed it becomes extremely difficult
to remove the appendix through the limited groin
incision. The chances of avulsion of a friable and
inflamed organ are extremely high. Therefore it is a safe
practice to perform a lower mid line laparotomy.7
At laparotomy the contents can be reduced safely from
within. A critical assessment of viability can be done
after reduction of the caecum and appendix. Formal
appendectomy can then be done with ease.
The next dilemma which the surgeon confronts during the
management of such cases is the choice of repair for the
femoral hernia.8
This choice should be decided based on
the status of the appendix. In cases of inflamed appendix
it would be a safe practice to avoid any prosthetic repair.
A simple closure of the femoral ring with a non-
absorbable suture will suffice. However if the appendix is
absolutely normal there is no indication to perform an
appendectomy. In such cases reduction of contents
through the groin incision can be easily accomplished. As
there is no breach in the lumen of the gastrointestinal
tract during the course of surgery, the surgeon can go
ahead with mesh plug repair. Though various case reports
have described mesh repair with appendectomy it would
be a risky proposition as chances of mesh infection are
high.9
Laparoscopic approach has also been described to
manage such cases.8
But in the presence of a severely
inflamed appendix, a laparoscopic approach may not
always be successful. Such cases may require conversion
to open surgery causing contamination of the operative
site predisposing to surgical site infection.
CONCLUSION
Although, De Garengeot’s hernia is an extremely rare
type of a hernia. High index of suspicion by virtue of
awareness of this condition can enable the surgeon to
make a presumptive preoperative diagnosis. Majority of
such cases are diagnosed intra operatively. Open
approach is the safest. If the appendix is inflamed with
severe surrounding sepsis it is a safe practice to tackle the
disease by performing a lower mid line laparotomy. A
mesh repair should be avoided in cases that undergo
appendectomy.
ACKNOWLEDGEMENTS
We would like to thank Parth K. Vagholkar for his help
in typesetting the manuscripts.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
REFERENCES
1. Thomas B, Thomas M, McVay B, Chivate J. De
Garengeot Hernia. JSJL. 2009;13(3):455-7.
2. Tancredi A, Bellagamba R, Cotugno M,
Impagnatiello E, La Torre P, Masi M, et al. De
Garengeot’s Hernia: a Diagnostic challenge. Indian
J Surg. 2015;77(2):147-9.
3. Ramsingh J, Ali A, Cameron C, Al-Ani A, Hodnett
R, Chorushy C. De Garengeot’s hernia: a diagnosis
and surgical management of a rare type of femoral
hernia. J Surg Case Rep. 2014;2014(2):rju008.
4. Piperos T, Kalles V, Ahwal Y, Konstantinou E,
Skarpas G, Sapsakos M. Clinical significance of de
Garengeot’s hernia: A case of acute appendicitis and
review of literature. Int J Surg Case Rep.
2012;3(3):116-7.
5. Caygill P, Nair R, Sajjanshetty M, Francis D. An
unusual groin exploration: De Garengeot’s hernia.
Int J Surg Case Rep. 2011;2(5):74-5.
6. Granvall SA. De Garengeot hernia: a unique
surgical finding. JAAPA. 2014;27(5):39-41.
7. Vagholkar K. Strangulated femoral hernia: a
challenging surgical vignette - case report and
review of literature. International Journal of Clinical
Medicine. 2014;5(2):72-5.
8. Sharma H, Jha PK, Shekhawat NS, Memon B,
Memon MA. De Garengeot hernia: an analysis of
our experience. Hernia. 2007;11(3):235-8.
9. Kalles V, Mekras A, Mekras D, Papapangiotou I,
Harethee W, Sotiropoulos G, et al. De Garengeot’
hernia: a comprehensive review. Hernia.
2013;17(2):177-82.
Cite this article as: Vagholkar K, Pawanarkar A,
Vagholkar S, Pathan K, Pathan S. De Garengeot’s
hernia: a surgical surprise. Int Surg J 2016;3:471-2.