Presentation
Right Iliac fossa pain radiating to the right groin of one week duration.
Patient Data
Right sided femoral hernia, protruding through the right pectineal fascia, into which the appendix appears to be herniating. The appendix appears dilated, shows thickening and enhancement of its wall. Free fluid is seen within the hernia sac. At the neck of the hernia sac, the appendix appears compressed.
Appearances suggest incarceration and inflammation of the appendix within the hernia sac.
Case Discussion
De Garengeot hernias account for less than 1% of all femoral hernias. Inflammation of the appendix occurs in a small fraction of these cases, approximately 0.08-0.13%. Incarceration of the appendix at the neck of the sac is thought to be to the cause of the inflammation rather than intraluminal obstruction.
This case also demonstrates a rare variant of femoral hernia, in which the sac protrudes through the pectineal fascia, termed Cloquet's hernia, instead of the conventional course into the femoral canal.
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