A combined Richter's and de Garengeot's hernia

INTRODUCTION: de Garengeot's hernia is very rare. Richter's hernia is responsible for 10% of acute strangulated hernias. PRESENTATION OF CASE: A 91-year-old woman with three days of abdominal distention was found on computed tomogram to have an incarcerated femoral hernia. Operation revealed a de Garengeot's hernia combined with a Richter's hernia of small bowel. Primary repair was performed along with appendectomy. DISCUSSION: We discuss these rare hernias, not previously reported in combination, and options for management. CONCLUSION: Combined de Garengeot's and Richter's hernias are rare, represent a significant diagnostic challenge, and should be repaired urgently to prevent ischemic bowel, or limit contamination if ischemia is already present. Use of computed tomography will likely lead to increased pre-operative diagnosis of this rare entity.