A Case of de Garengeot Hernia Complicated with Appendicitis Treated with Elective Femoral Hernia Repair

Abstract

An 86-year-old man with a history of poorly controlled asthma presented to our hospital with an asthma attack, which resolved after inhaled medication. However, he subsequently developed right inguinal swelling and epigastric pain. An abdominal CT scan revealed an incarcerated appendix in the right femoral hernia (de Garengeot hernia). Mild appendicitis was diagnosed, and conservative treatment with antimicrobials was initiated. Due to the recurrent nature of the femoral hernia, we performed hernia repair via an inguinal incision under spinal anesthesia after the appendicitis had resolved. An appendectomy was not performed as the patient had severe mixed ventilatory impairment and could not tolerate surgery. To date, no recurrence of appendicitis has been reported. In mild cases of appendicitis, such as the present case, conservative treatment may be effective if the physical obstruction of the appendiceal lumen associated with the incarcerated femoral hernia is relieved, suggesting that appendectomy may not always be necessary. Considering the severity of appendicitis and the outcomes of conservative treatment, we have summarized the treatment strategies for de Garengeot hernias at our hospital.