A de Garengeot hernia is a rare type of femoral hernia in which the appendix is contained within the femoral hernia sac. Femoral hernias represent approximately 3% of all hernias. The presence of the appendix in a femoral hernia occurs in 0.8% to 1% of all femoral hernias or 0.024% to 0.03% of all hernias. Although this condition was first described by Dr. de Garengeot in 1731, its rareness has led to relatively few cases being reported in the literature and no consensus for a standard approach to management. This report presents the case and discusses the management of a 74-year-old woman who presented with an incarcerated DeGarengeot hernia, during which the hernia was repaired in an open Liechtenstein fashion without appendectomy. She presented with a new right groin bulge and pain. The pre-operative CT scan demonstrating the presence of the appendix within the femoral hernia can be seen in Figure 1. The decision was made to proceed with an open hernia repair, with possible appendectomy if the appendix was found to be inflamed or unable to be reduced. As seen in Figure 2 the appendix was soft and non-inflamed. However, the peri-appendiceal mesentery was scarred and adherent to the hernia sac. Through careful dissection, the appendix was able to be freed from the hernia sac and successfully reduced. As we were able to avoid transecting the appendix the procedure remained clean and were able to repair the hernia with non-absorbable mesh. Post-operatively patient was carefully monitored for new onset signs and symptoms of iatrogenic appendicitis from intraoperative manipulation. The patient did not develop any signs or symptoms of appendicitis and was sent home on post-operative day 1. In summary, this is a case of a 74-year-old woman who presented with a very rare femoral hernia containing the appendix, also known as the de Gargengeot hernia.
