scholarly journals 1412 De Garengeot's Hernia Complicated by Perforated Appendicitis and Groin Abscess: Report of A Rare Surgical Emergency

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Singh ◽  
A Abdelrahman ◽  
S Abdalla
Keyword(s):  
Femoral Hernia ◽  
Perforated Appendicitis ◽  
Vermiform Appendix ◽  
Abscess Cavity ◽  
Cross Sectional ◽  
Gold Standard Method ◽  
Cross Sectional Imaging ◽  
De Garengeot’S Hernia ◽  
The Right ◽  
Groin Abscess

Abstract Introduction De Garengeot's hernia is a rare subtype of femoral hernia which contains the vermiform appendix. Acute appendicitis in a femoral hernia is even more unusual, accounting for 0.08% - 0.13% of all cases of femoral hernias. Case presentation A 91-year-old woman was referred with a painful, cellulitic right groin mass. A computed tomography scan demonstrated a right-sided femoral hernia containing a loop of bowel and a collection in the right groin containing fluid and gas. The patient had early dementia but no other major medical co-morbidities. At surgery, she was found to have perforated appendicitis in a right femoral hernia. Most of the appendix and sac had fully disintegrated, forming a large abscess cavity beneath the skin in the right groin which extended down to the upper labia majora. The appendix tip was lying deep within the abscess cavity. A modified McEvedy approach was used to access the peritoneal cavity for the appendicectomy and sutured repair of the femoral neck. The groin abscess cavity was drained and managed with a negative pressure (VAC) dressing. Discussion De Garengeot's hernia is often difficult to diagnose pre-operatively and reporting of cross-sectional imaging may not always be reliable. Currently, there is no gold standard method for repairing these hernias. However, the modified McEvedy approach is well-described and is the preferred technique for emergent femoral hernia presentations. It provides sufficient access to manage both appendicitis and the femoral hernia. Adjuncts such as negative pressures dressings may be used to manage concomitant abscess cavities.

scholarly journals Type 4 appendiceal diverticulum within a de Garengeot hernia

2016 ◽  
Vol 98 (7) ◽  
pp. e141-e142 ◽  
Author(s):  
SH Rossi ◽  
E Coveney
Keyword(s):  
Femoral Hernia ◽  
Cystic Lesion ◽  
Vermiform Appendix ◽  
Clinical Suspicion ◽  
Intraluminal Pressure ◽  
Rare Entity ◽  
History Of ◽  
The Right ◽  
De Garengeot Hernia ◽  
Learning Points

A de Garengeot hernia is defined as an incarcerated femoral hernia containing the vermiform appendix. We describe the case of a patient with a type 4 appendiceal diverticulum within a de Garengeot hernia and delineate valuable learning points.A 76-year-old woman presented with a 2-week history of a non-reducible painless femoral mass. Outpatient ultrasonography demonstrated a 36mm × 20mm smooth walled, multiloculated, partially cystic lesion anterior to the right inguinal ligament in keeping with an incarcerated femoral hernia. Intraoperatively, the appendix was found to be incarcerated in the sac of the femoral hernia and appendicectomy was performed. Histopathology demonstrated no evidence of inflammation in the appendix. However, an incidental appendiceal diverticulum was identified.It is widely recognised that a de Garengeot hernia may present with concomitant appendicitis, secondary to raised intraluminal pressure in the incarcerated appendix. Appendiceal diverticulosis is also believed to develop in response to raised pressure in the appendix and may therefore develop secondary to incarceration in a de Garengeot hernia. To our knowledge, only one such case has been described in the literature. A de Garengeot hernia is a rare entity, which poses significant diagnostic challenges. A high index of clinical suspicion is necessary as these hernias are at particularly high risk of perforation and so prompt surgical management is paramount.

Systemic arteriopulmonary venous fistula (APVF): case presentation of an asymptomatic individual and a review of the literature

2021 ◽  
Vol 14 (7) ◽  
pp. e241644
Author(s):  
Paul Jenkins ◽  
Prageeth Dissanayake ◽  
Richard Riordan
Keyword(s):  
Chest Radiograph ◽  
Cardiovascular Health ◽  
Incidental Finding ◽  
Chest Radiographs ◽  
Cross Sectional ◽  
Arterial Circulation ◽  
Cross Sectional Imaging ◽  
Venous Fistula ◽  
The Right

Abnormal communications between the systemic and pulmonary venous systems are rare but can present as a opacity on chest radiograph. A solitary vessel communicating as a fistula directly between the systemic arterial circulation and the pulmonary venous system is not widely described. These may have significant implications in the long-term cardiovascular health of an individual acting as a left to right shunt. There is no clear consensus as to the management, but surgical management and endovascular embolisation have been successfully used. We present a case where a systemic arteriaopulmonary fistula originating from the abdominal aorta and connecting to the right inferior pulmonary vein manifested as an incidental finding on a chest radiograph and was further evaluated on cross-sectional imaging in a young patient. Chest radiographs are non-specific and it is important to be aware of the less frequent but important pathologies that can be picked up on plain chest radiographs, which inturn should warrant further investigation. This is presented in conjunction with a review of the available literature along with a discussion regarding the differential diagnosis and management applicable to the general clinician.

Case 9.28

2014 ◽  
pp. 476-477
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Small Bowel ◽  
Cross Sectional ◽  
New Era ◽  
True Incidence ◽  
Live Births ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
The Right ◽  
Left Abdomen

11-year-old boy with suspected IBD Coronal SSFSE images (Figure 9.28.1) demonstrate abnormal orientation of large and small bowel, with small bowel in the right abdomen and colon in the left abdomen. Malrotation Classic thinking regarding malrotation holds that most cases are detected within the first few months of life. However, in the new era of cross-sectional imaging for everyone, more and more adults with asymptomatic malrotations are noted and the true incidence is not entirely certain. Estimates in the literature range from 1 in 6,000 to 1 in 200 live births. Autopsy studies suggest that some form of malrotation exists in 0.5% to 1% of the population....

Sectional anatomy of the ventricular septal defect in double outlet right ventricle—correlation of magnetic resonance images from autopsied hearts with anatomic sections

1993 ◽  
Vol 3 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Shi-Joon Yoo ◽  
Siew Yen Ho ◽  
Philip J. Kilner ◽  
Jeong-Wook Seo ◽  
Robert H. Anderson
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricle ◽  
Septal Defect ◽  
Double Outlet Right Ventricle ◽  
Magnetic Resonance Images ◽  
Cross Sectional ◽  
Posterior Limb ◽  
Imaging Characteristics ◽  
Cross Sectional Imaging ◽  
The Right

AbstractA ventricular septal defect is, almost always, an integral part of double outlet right ventricle and has been classified into the subaortic, subpulmonary, doubly committed and non-committed varieties. This study was performed to correlate the cross-sectional imaging characteristics of such ventricular septal defect in double outlet right ventricles using pathological specimens. The extent and the orientation of the outlet septum were the most important in the differentiation of the four varieties of ventricular septal defect. In the subaortic variety, the outlet septum fused with the left anterior margin of the defect, this being marked by the anterior limb of the septomarginal trabeculation. In the subpulmonary variety, the outlet septum fused with the right posterior margin of the defect, this being the posterior limb of the septomarginal trabeculation. The outlet septum was vestigial in case with doubly committed defects. In those with non-committed defects, the defect was not shown in those images or sections which demonstrated the outlet septum.

scholarly journals De Garengeot’s Hernia: Two Case Reports with Correct Preoperative Identification of the Vermiform Appendix in the Hernia

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Zhaosheng Jin ◽  
Muhammad Rafiz Imtiaz ◽  
Henry Nnajiuba ◽  
Suzette Samlalsingh ◽  
Akinyede Ojo
Keyword(s):  
Hernia Repair ◽  
Gold Standard ◽  
Femoral Hernia ◽  
Case Reports ◽  
Vermiform Appendix ◽  
Case Control ◽  
Case Control Studies ◽  
Intravenous Contrast ◽  
De Garengeot’S Hernia

We present two cases of incarcerated de Garengeot’s hernia. This anatomical phenomenon is thought to occur in as few as 0.5% of femoral hernia cases and is a rare cause of acute appendicitis. Risk factors include a long pelvic appendix, abnormal embryological bowel rotation, and a large mobile caecum. In earlier reports operative treatment invariably involves simultaneous appendicectomy and femoral hernia repair. Both patients were correctly diagnosed preoperatively with computed tomography (CT). Both had open femoral hernia repair, one with appendectomy and one with the appendix left in situ. Both patients recovered without complications. Routine diagnostic imaging modalities such as ultrasonography and standard CT have previously shown little success in identifying de Garengeot’s hernia preoperatively. We believe this to be the first documented case of CT with concurrent oral and intravenous contrast being used to confidently and correctly diagnose de Garengeot’s hernia prior to surgery. We hope that this case report adds to the growing literature on this condition, which will ultimately allow for more detailed case-control studies and systematic reviews in order to establish gold-standard diagnostic studies and optimal surgical management in future.

Creating diagnostic criteria for perforated appendicitis using cross-sectional imaging

2017 ◽  
Vol 33 (9) ◽  
pp. 1007-1012
Author(s):  
Joseph T. Church ◽  
Megan A. Coughlin ◽  
Alexis G. Antunez ◽  
Ethan A. Smith ◽  
Steven W. Bruch
Keyword(s):  
Diagnostic Criteria ◽  
Perforated Appendicitis ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

scholarly journals Aseptic abscess syndrome

2020 ◽  
Vol 13 (10) ◽  
pp. e236437
Author(s):  
Hannah Fillman ◽  
Patricio Riquelme ◽  
Peter D Sullivan ◽  
André Martin Mansoor
Keyword(s):  
Abdominal Pain ◽  
Immunosuppressive Agents ◽  
High Dose ◽  
Cross Sectional ◽  
Abdominal Abscesses ◽  
Intravenous Antibiotics ◽  
Cross Sectional Imaging ◽  
Aseptic Abscess ◽  
Intravenous Steroids ◽  
The Right

A 43-year-old woman with Crohn’s disease was admitted to the hospital with weight loss and 1 week of fever, abdominal pain and diarrhoea. At presentation, the patient was not on steroids or other immunosuppressive agents. Cross-sectional imaging of the abdomen revealed active colitis and multiple splenic and hepatic abscesses. All culture data were negative, including aspiration of purulent material from the spleen. Despite weeks of intravenous antibiotics, daily fever and abdominal pain persisted, the intra-abdominal abscesses grew, and she developed pleuritic chest pain and consolidations of the right lung. The patient was ultimately diagnosed with aseptic abscess syndrome, a rare sequelae of inflammatory bowel disease. All antimicrobials were discontinued and she was treated with high-dose intravenous steroids, resulting in rapid clinical improvement. She was transitioned to infliximab and azathioprine as an outpatient and repeat imaging demonstrated complete resolution of the deep abscesses that had involved her spleen, liver and lungs.

De Garengeot’s Hernia; Acute Appendicitis In An Incarcerated Femoral Hernia

2015 ◽  
Vol 87 (7) ◽  
Author(s):  
Maciej Kokoszka ◽  
Jacek Wójtowicz
Keyword(s):  
Acute Appendicitis ◽  
Emergency Room ◽  
Female Patient ◽  
Femoral Hernia ◽  
Therapeutic Process ◽  
Diagnostic Difficulties ◽  
History Of ◽  
De Garengeot’S Hernia ◽  
Painful Mass ◽  
The Right

AbstractAcute appendicitis and incarcerated femoral hernia belong to relatively well known surgical diseases with regard to diagnostic workup and treatment. de Garengeot’s hernia is an entity involving concurrent occurrence of both the above mentioned problems.This paper presents history of a 58-year old female patient who was diagnosed with this extremely rare syndrome. She presented to the Emergency Room of a hospital in Żyrardów due to painful mass in the right groin region, persisting for approximately 24 hours.De Garengeot’s hernia, through combination of two separate surgical entities, is associated with diagnostic difficulties and the therapeutic process occasionally requires unconventional decisions to be taken to improve prognosis.

scholarly journals A Rare Case of Chronic Appendicitis Superimposed on an Incarcerated de Garengeot Hernia Prospectively Identified on Computed Tomography

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Alyssa Goldbach ◽  
Partha Hota ◽  
Andrew Czulewicz ◽  
Christine Burgert-Lon ◽  
Omar Agosto
Keyword(s):  
Femoral Hernia ◽  
Surgical Intervention ◽  
Incidental Finding ◽  
Critical Role ◽  
Fluid Collection ◽  
Cross Sectional ◽  
Chronic Appendicitis ◽  
Hernia Sac ◽  
Cross Sectional Imaging ◽  
De Garengeot Hernia

The de Garengeot hernia is an uncommon and potentially confounding pathologic process in which the appendix is contained within a femoral hernia. While typically a benign incidental finding, superimposed acute appendicitis is a rare but serious complication. Identification of this entity is crucial to patient management and ultimately outcome with imaging playing a critical role. Cross-sectional imaging, with either CT or MRI, should be performed in all cases of suspected incarcerated de Garengeot hernia to facilitate the appropriate diagnosis and surgical intervention. Herein, we present the fifth case of a prospective CT diagnosis of the de Garengeot hernia in a 61-year-old female who presented with an irreducible right femoral hernia. The patient underwent CT examination which demonstrated the appendix within the femoral hernia sac with an associated periappendiceal fluid collection. The patient was taken for emergent surgical intervention at which time the appendix was found within the hernia sac. The appendix was removed, the defect repaired, and ultimately the patient recovered well.

scholarly journals The rare case of De Garengeot hernia: femoral hernia containing perforated appendicitis

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Lei Ying ◽  
Jeong-Moh John Yahng
Keyword(s):  
Femoral Hernia ◽  
Rare Case ◽  
Clinical Symptoms ◽  
Perforated Appendicitis ◽  
Vermiform Appendix ◽  
Hernia Sac ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Groin Hernias ◽  
De Garengeot Hernia

Abstract Femoral hernias account for ~4% of all groin hernias but are much more common in females, especially those over the age of 70. Risk of incarceration is overall low but can include structures such as bowel, omentum, bladder, ovary and very rarely, the appendix. The subset of femoral hernias containing the vermiform appendix is known as de Garengeot hernias. We describe a rare case of an 87-year-old female patient who presented with an incarcerated right femoral hernia confirmed on contrast-enhanced computed tomography scan of the abdomen and pelvis, with subsequent open hernia reduction revealing a perforated necrotic appendix with pus contained in the hernia sac. Histopathology revealed acute appendicitis with increased stromal fibrosis suggestive of a chronic process. Pre-operative diagnosis of de Garengeot hernias remains challenging due to their non-specific presentation and attenuated clinical symptoms, and most diagnoses are made intraoperatively.

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