title: A De Garengeot Hernia masquerading as a strangulated femoral hernia.
abstract: BACKGROUND
  De Garengeot hernia is a rare occurrence whereby an appendix is found in a femoral hernia sac. It is rarer still to find an acutely inflamed appendix manifesting itself as a strangulated femoral hernia. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon.
  
  
  METHODS
  We report the case of an 86 year old female who was found to have a De Garengeot hernia containing a necrotic appendix. A retrograde appendicectomy was performed to prevent peritoneal contamination. The hernia defect was repaired using a standard repair with non-absorbable suture.
  
  
  CONCLUSIONS
  De Garengeot's hernia is a rare occurrence, is often unexpected and tends to be diagnosed intra-operatively. Pre-operative diagnosis remains difficult and it will often masquerade as a strangulated femoral hernia. In stable patients, where there is a diagnostic uncertainty CT scanning is a useful adjunct and may allow a laparoscopic approach to be undertaken in the absence of appendicitis.
  
  
  CONCLUSIONS
  A De Garengeot's hernia should be considered as a differential diagnosis in patients presenting with clinical signs of a strangulated femoral hernia. It is often an incidental finding during an emergency operation. Although mesh repairs in the presence of appendicitis have been reported, the safest approach remains a primary suture repair.
authors.affiliation: Watford General Hospital, Vicarage Road, Watford WD18 0HB, United Kingdom. Electronic address: ahussain89@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Hussain
authors.affiliation: Watford General Hospital, Vicarage Road, Watford WD18 0HB, United Kingdom.
authors.forename: A A P
authors.initials: AA
authors.lastname: Slesser
authors.affiliation: Watford General Hospital, Vicarage Road, Watford WD18 0HB, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Monib
authors.affiliation: Watford General Hospital, Vicarage Road, Watford WD18 0HB, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Maalo
authors.affiliation: Watford General Hospital, Vicarage Road, Watford WD18 0HB, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Soskin
authors.affiliation: Watford General Hospital, Vicarage Road, Watford WD18 0HB, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Arbuckle