A rare presentation of appendicitis inside the femoral canal: case report and literature review

BACKGROUND: Femoral hernia accounts for 3% of all the hernias, and in 0.5–5% of cases, the appendix can migrate through the femoral hernia and is called de Garengeot hernia. It is a very rare condition, and the incidence of appendicitis in this type of hernia is as low as 0.08–0.13%. CASE PRESENTATION: We bring into discussion a case of a 47-year-old female who presented to the emergency department with a painful right-sided groin lump for the past 2 days. After initial resuscitation, a CT scan was requested which showed the presence of inflamed appendix inside the femoral canal. She was taken to the operative theatre, and during the laparoscopy, the appendix was identified migrating through the femoral canal and it could not be retracted into the peritoneal cavity; therefore, the mesoappendix was divided and the operation converted to the open low approach. After identifying the femoral hernia sac and opening it, the appendix was removed and herniorrhaphy was performed. Our patient had an uneventful recovery and was discharged on the following day. CONCLUSION: We report a rare case of de Garengeot hernia which was diagnosed preoperatively. Because of its non-specific presentation, patients are usually diagnosed with incarcerated femoral hernia and are taken to operative theatre and the final diagnosis is made intra-operatively. Due to its rarity, there is no standard approach for this condition, and emergency appendicectomy and concurrent herniorrhaphy is the mainstay of treatment. In this paper, we present different surgical methods for the treatment of this type of hernia.