De Garengeot appendicitis

Case contributed by Henry Knipe
Diagnosis almost certain

Presentation

Two day history of painful right groin lump.

Patient Data

Age: 70 years
Gender: Female
ultrasound
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Info

Right groin hernia containing a blind ending bowel loop measuring up to 9 mm in dimension with mural hyperemia very suggestive of appendicitis. Small volume of adjacent free fluid.

ct
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Coronal C+ portal
venous phase
This study is a stack
Sagittal C+ portal
venous phase
Oblique MPR C+
portal venous phase
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Info

CT confirms a direct right groin hernia containing the appendix with the herniated appendix dilated with mucosal hyperenhancement and a small volume of surrounding free fluid and fat stranding. The hernia sac remains lateral to the pubic tubercle with slight compression of the femoral vein adjacent to the neck.

Case Discussion

Femoral hernias containing the appendix are rare, and with superimposed appendicitis even rarer. The patient was transferred to another hospital and histological confirmation of appendicitis is not available. 

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