Garengeot hernia: preperitoneal approach in the context of strangulation, case report

Orlando Rodríguez-Hernández, Servicio Social, Benemerita Universidad Autonoma de Puebla, Puebla, Mexico
Martín U. Vázquez-Medina, Departamento de Cirugía General, Hospital Universitario de Puebla, Puebla, Mexico
Simón Reyes-Silva, Departamento de Cirugía General, Hospital General de Zacatlán, Puebla, Mexico

Garengeot’s hernia is a femoral hernia in which the cecal appendix is located within the hernial sac; it is most common in adult or postmenopausal women. Its pathophysiology relates to the narrowness of the femoral ring and the abnormal attachment of the cecum, factors that increase the risk of incarceration and strangulation. Clinically, it presents as pain in the inguinal region, accompanied by an irreducible mass, which can sometimes be less evident, hence the difficulty in diagnosis, with most cases identified during surgery. Computed tomography helps guide the diagnosis and rules out the main differential diagnosis, Amyand’s hernia. Treatment is surgical, individualized, and urgent, without standardization; the approach depends on the surgeon’s experience. The main goal is to evaluate the appendix’s condition, as this will determine whether a crural or inguinal approach is used for hernia repair or hernioplasty to prevent infection of the prosthetic mesh. We present the case of a patient initially diagnosed with a strangulated right inguinal hernia, presenting with pain and a palpable mass in the region. However, at the time of surgery, it was found that she had a femoral hernia that included the appendix; herniorrhaphy with prosthetic material placement was performed, followed by appendectomy. This represents a surgical condition of clinical interest.

Keywords: Garengeot hernia. Appendicular strangulation. Amyand hernia. Preperitoneal repair. Femoral hernia.