The Hidden Appendix: A Rare Encounter with De Garengeot Hernia

De Garengeot hernia is a rare subtype of femoral hernia characterized by the presence of the appendix within the femoral canal. First described in 1731, this condition accounts for only 0.5% to 3.3% of femoral hernias, with acute appendicitis occurring in approximately 0.13%–1% of all cases. The pathophysiology of this entity remains debated, with hypotheses suggesting either displacement due to anatomical variations or abnormal embryological development. Patients often present with an irreducible, tender groin mass, sometimes accompanied by fever and systemic symptoms, making preoperative diagnosis challenging. Imaging modalities such as computed tomography (CT) scans can aid in diagnosis, though many cases are only identified intraoperatively. Standard treatment involves emergency appendectomy and femoral herniorrhaphy, with the surgical approach determined by intraoperative findings. Open surgery remains the preferred method, particularly in cases of perforation, though laparoscopic techniques have been explored. The use of mesh in hernia repair is debated, especially in the presence of infection. This case report highlights a patient who presented with a tender, irreducible groin mass, initially suspected as an obstructed femoral hernia. Imaging failed to confirm the diagnosis, and intraoperative findings revealed a de Garengeot hernia with acute appendicitis. The patient underwent successful appendectomy and non-mesh hernia repair, with an uneventful postoperative recovery. Due to its rarity and nonspecific presentation, De Garengeot hernia remains a diagnostic and surgical challenge. Heightened clinical suspicion, timely imaging, and early surgical intervention are crucial for optimizing outcomes. This case underscores the importance of considering this rare entity in patients presenting with groin masses, particularly in elderly women, to prevent delays in diagnosis and treatment.