A Rare Case of De Garengeot Hernia With Acute Appendicitis: Diagnostic and Surgical Challenges in a Regional Setting.

Abstract

Appendicitis and incarcerated groin hernias are common surgical emergencies, typically managed independently. A De Garengeot hernia, defined as a femoral hernia containing the vermiform appendix, represents a rare convergence of both pathologies and poses unique diagnostic and operative challenges, particularly in resource-limited, regional settings. We present a case of a patient who arrived at a regional hospital with a painful, irreducible right-sided groin lump. CT imaging revealed a De Garengeot hernia with associated acute appendicitis. The patient underwent laparoscopic appendicectomy followed by open femoral hernia repair using suture technique without mesh, due to intraoperative evidence of inflammation and contamination. A hernia diagnosis is often clinical, but imaging is often used in stable patients to clarify anatomy and guide management. Surgical decision-making must consider contamination risk, with mesh repair avoided in infected fields to minimise complications such as mesh infection and recurrence. This case highlights the importance of early imaging, individualised surgical planning, and flexibility in operative approach when managing rare pathologies like De Garengeot hernia with acute appendicitis in regional environments. Awareness of this entity and appropriate surgical strategy can lead to successful outcomes, even in resource-limited settings.