Journal of Universal Surgery

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Acute Appendicitis in De Garengeot Hernia - A Systematic Review

Allu VJ*, Basu S, Chowdhury A, Shrestha A and Shah A

Introduction: Presence of appendix within a Femoral Hernia is a rare pathology named eponymously as De Garengeot’s hernia that is mostly identified as an incidental finding during exploration for an incarcerated Femoral Hernia and even rarer is the incidence of acute appendicitis in these cases.

Aim: To undertake a systematic review of the published case reports, focussing on the incidence of acute appendicitis within a De Garengeot hernia, the relationship between pre-operative diagnosis and surgical technique, as well as the incidence and surgical outcome.

Materials and Methods: A PRISMA modelled literature search was carried out across PubMed, ProQuest, and BMW Case Report databases with the search terms ‘Femoral Hernia’, ‘Appendix’, ‘De Garengeot’s’ in various combinations, limited to English language, published between 1960 to 2019. Authors report another case report, not included in the systematic review.

Results: Systematic review identified 83 published data reporting 111 cases. 74 (66%) cases presented with painful groin swellings. Computerised Tomography performed in 43 (38%) accurately diagnosed De Garengeot’s in 32 (74%) patients. The most common surgical approach was Lockwood’s low approach 35 (31%) followed by the Lotheissen’s approach 23 (21%). 81 (72%) underwent herniorrhaphy with non-absorbable sutures and 20 had mesh repairs (18%). Ten (9%) patients were reported to have postoperative morbidity with wound infection being the most common complication and one recorded death.

Conclusion: Rarity of De Garengeot’s hernia is shown by the limited availability of data that restricted the author’s ability to conclude a single diagnostic pathway or a specific surgical technique for this condition. CE CT is shown to be a relatively accurate form of imaging tool, as well as Ultrasound scans in the event that there was accessibility issue. Sequestrated appendicectomy and hernia repair via laparoscopy could be an option; however, there is lack of data to warrant its effectiveness as the surgical option of choice over an open groin approach in the presence of an incarcerated groin swelling.