International Journal of Recent Scientific Research

De Ganregeot hernia is a rare type of incarcerated femoral hernia. In literature, the gold standard treatment is not established, although previous reports suggested various surgical approach in relation to patient conditions, comorbidities, surgeon preferences and clinical findings during surgery. Case presentation: A 75-year-old female was admitted in emergency at our Surgical Department for strangulated femoral hernia. The patient was submitted to open surgical treatment, appendicectomy was performed and femoral hernia with self-fixating mesh was repaired. During this procedure a iatrogenic lesion of a right aberrant obturator artery has done and immediately controlled through the same open incision. The post-operative period was uneventful, with no further issues at follow up. Histopathological examination confirmed the diagnosis of phlegmonous and hemorrhagic appendicitis.

De Garengeot hernia is diagnosed intraoperatively and there are few cases that imaging already led to establish a pre-operative diagnosis. This is a rare case of dual pathology with also an aberrant artery anomalous anatomic condition found in less of 30% of cases. About 30-40% of cases the treatment of De Garengeot hernia is emergency. In relation to various surgical treatment described in literature, we suggest a new DAC classification (D=description af appendix; A=Alvarado score; C=Computed tomography imaging) for conducting surgeon to choise the correct surgical approach in this rare type of hernia. We suggest that the approach through the transverse subinguinal Nyhus's incision in both appendectomy and herniorrhaphy in cases of De Garengeot hernia furthermore with likely presence of anatomic anomalies. De Garengeot hernia is often only made intra-operatively due to its irregular clinical presentation and it must be differentiated from: Amyand hernia, Littre hernia and Maydl hernia.