2019 General Surgery Presentations

Timothy M Guenther, MD1, Jim Becker, MD2, Nalani Grace, MD3, James Wiedeman, MD3; 1David Grant Medical Center, Travis AFB/UC Davis, 2UC Davis, 3Sacramento VA Medical Center - VA Northern California Health Care System

Introduction: A De Garengeot’s hernia is a femoral hernia that contains the appendix. This rare type of hernia was first described by René-Jacques De Garengeot in 1731. Numerous case reports have been published since then, yet the last extensive review of the literature was published in 1925. We present two cases of a De Garengeot’s hernia and provide a comprehensive literature review of other published cases since 1925. A classification system based on the gross appearance of the appendix and related structures is also proposed.

Methods: A literature review was undertaken using PubMed, Google-Scholar, and our institutional library database for case reports of a femoral hernia containing the appendix. In addition, basic demographic information of the patient (age/gender), presenting symptoms and/or physical exam findings, and a gross description of the appearance of the appendix and related structures within the femoral hernia was required for inclusion. Additional information from each case reports that met eligibility was gathered and all data were tabulated in Microsoft Excel. A classification system was created based on the gross appearance of the appendix and any other involved structures within the femoral hernia, and each case report was categorized using this classification system. Categorical data were analyzed with a χ2 test and numeric data with a student t test to determine significance. The literature search and data analysis took place between 2/2018-5/2018.

Results: A total of 177 cases were identified in 155 articles. Cases were most commonly performed in Europe, but case reports were published globally. Most cases occurred in females (79.7%) and the most common presenting symptom was pain and a bulge located in the groin (81.4% and 85.9% respectively). In 94.3% of cases, a groin bulge was observed on physical exam and erythema over the hernia was present 33.3% of the time. A pre-operative diagnosis was established in 23.7% of cases and the most common approach for repair was through a groin incision. 11.3% of cases were associated with a complication, a surgical site infection being the most common. Based on our classification system, the most common stage was stage 2A, corresponding to a congested/inflamed appendix, which was found in 42.4% of cases.

Conclusions: De Garengeot’s hernias are a rare and clinically heterogeneous type of hernia as highlighted by our proposed classification system. Acute care surgeons should be aware of this type of hernia for the interesting set of diagnostic/management challenges this condition presents.