Presentation
Sudden onset right groin pain and swelling. Raised inflammatory markers.
Patient Data
Appendix within a right femoral hernia (note the mass effect on the medial wall of femoral vein indicating that this is in the femoral space, and lies superficial to pectineus muscle). Peri-appendiceal fat stranding consistent with acute appendicitis. Calcified stone within non-inflamed gall bladder. Uncomplicated sigmoid diverticulosis.
PATHOLOGY
Specimen:
Appendix.
Clinical History:
Appendix, inflamed in fascia and found during femoral hernia repair.
Macroscopic:
Appendix 75mm long with mesoappendix 20x55x5mm. Area of hemorrhage involving appendix and mesoappendix 35x15x5mm. No perforation identified.
Microscopic:
This appendix shows congestion and hemorrhage within the adjacent fat with hemorrhage and congestion within the mucosa of part of the appendix. There is no acute transmural inflammation and no serosal reaction. No helminths are identified and there is no evidence of malignancy.
Comment:
There are no features of acute appendicitis. There is a focal mesothelial reaction with hemorrhage and congestion within the appendix and the fat in keeping with the clinical history of the appendix being identified within a hernia.
Case Discussion
The pathology confirms that there was no primary appendical inflammation, but rather congestion of the mesoappendix as a result of being trapped within the femoral hernia sac. Contrast this De Garengeot hernia with an Amyand hernia, in which the appendix lies within an inguinal hernia. Note that these named hernias simply imply that the appendix lies within a particular type of hernia, not that there is necessarily appendicitis.