Two-stage laparoscopic management of De Garengeot hernia with gangrenous appendicitis: a case report and literature review.

Abstract

Introduction and importance: De Garengeot hernia (DGH), the presence of the appendix within a femoral hernia sac, is exceptionally rare, and acute appendicitis in this setting is even less common. Management is challenging, particularly regarding mesh placement in contaminated fields. This report describes the first two-stage laparoscopic repair with bilateral mesh placement for gangrenous DGH in a young patient.

Case presentation: A 44-year-old woman presented with right-sided groin pain and swelling. Examination revealed a tender right inguinal mass without systemic signs. Computed tomography (CT) demonstrated a femoral hernia containing an inflamed appendix. Laparoscopy confirmed a gangrenous, non-perforated appendix and revealed a contralateral femoral defect. Appendectomy was performed, and repair was deferred due to contamination risk supported by positive peritoneal cultures. Four weeks later, elective laparoscopic transabdominal preperitoneal (TAPP) repair with bilateral polypropylene mesh was performed. Recovery was uneventful, and the patient remained asymptomatic at 6 months.

Clinical discussion: DGH may lack typical appendicitis signs due to the confined femoral canal. CT is the most reliable diagnostic tool but provides preoperative diagnosis in only one-third of cases. The combination of gangrenous appendicitis, positive cultures, and a contralateral defect justified a staged approach. Mesh offers superior recurrence prevention but should be avoided in contaminated settings. Laparoscopy enabled safe appendectomy, complete abdominal evaluation, and later bilateral repair.

Conclusion: Staged laparoscopic management is safe and effective for gangrenous DGH, permitting clean-field mesh repair and reducing recurrence risk.