An 83-year-old woman presented with a 1-week history of an enlarging, painful bulge in the right groin. Examination of the abdomen revealed a diffusely tender and erythematous right-groin mass extending to the right labium (Panel A). The examination was otherwise unremarkable. On exploration of the right groin, an abscess was found and drained, and necrotic tissue was observed within the femoral canal. An infraumbilical abdominal incision was made.
The appendix, with a necrotic distal portion (Panel B), was found within the femoral canal. The presence of a vermiform appendix in a femoral hernia sac, termed de Garengeot's hernia, was first described in 1731, which was 5 years before the first reported appendectomy.
De Garengeot's hernia is often misdiagnosed as an incarcerated or strangulated femoral hernia. It is distinct from Amyand's hernia, in which the appendix is within an inguinal hernia sac. In this case, we performed an open appendectomy, and the hernia was primarily closed. Full wound closure was noted during a follow-up visit.
Chung and Goel NEJM 361 (11): e18, September 10, 2009
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