CT
FINDINGS: Large right femoral hernia, containing the appendix. The appendix tip is abnormally dilated at 11 mm diameter, and displays a hypoenhancing wall with moderate volume of adjacent fluid, suspicious for ischaemia and perforation. The hernia sac also contains a moderate volume of fat. The sac wall is thickened and there is marked inflammatory stranding of the adjacent subcutaneous fat. As expected, the common femoral vein is severely effaced by the hernia, but remains patent. The common femoral artery is normal.
No other acute bowel abnormality. No other abdominal wall hernia. Normal urinary bladder. No pelvic cyst or mass. Hysterectomy. No acute bony abnormality. Left total hip arthroplasty.
IMPRESSION: Acute appendicitis with suspicion for perforation at the tip, contained within a right femoral hernia (De Garengeot hernia). There is also inflammatory change of the sac wall, which could represent strangulation, or could be secondary to appendicitis.