Presentation
Chills and decreased appetite. She had a bulge in her right groin.
Patient Data
The CT shows a right femoral hernia (below the inguinal ligament) containing the appendix. There is fat stranding and a small amount of fluid in the hernia sac. Oral contrast does not extend through the entirety of the appendix. This was diagnosed as a De Garengeot hernia with acute appendicitis. The coronal MIP image shows the course of the appendix from the cecum into the right femoral hernia.
Case Discussion
Femoral hernias are more common on the right side and are more common in females, as seen in this case.
The presence of the appendix within a femoral hernia is referred to as a De Garengeot hernia. This is distinct from an Amyand hernia, where the appendix is present within an inguinal hernia. Note that a Duari hernia is a femoral hernia that contains both the appendix and cecum.
The pathophysiology of appendicitis in the setting of a De Garengeot hernia is unclear. It could be two coincident events i.e. appendicitis and a femoral hernia, or it could be strangulation of the appendix due to the femoral hernia.
The patient was offered hernia repair with appendectomy but she refused surgery as her symptoms improved without any intervention. She is alive and well 1 year later. Although the hernia was not reducible on physical exam, it is possible that the extension of the appendix into the hernia was intermittent. In retrospect, a CT from 2 months prior to the above CT showed a right femoral hernia but without any extension of the appendix into the hernia at that time.
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