De Garengeot’s hernia: Case report and literature review

•De Garengeot’s hernias constitute an extremely rare condition associated with emergency surgery.•Suspicion and experience are crucial for correct management, as no therapeutic or diagnosis consensus has been reached.•A single surgical procedure can be performed to treat both pathologies; incarcerated hernia and strangulated appendix.•An open preperitoneal approach permits correct visualization of the sac contents and permits appendectomy and hernia repair.•When a complication is found, such as local perforation or abscess, a two-step abdominal wall repair should be considered. De Garengeot’s Hernia is a rare type of femoral hernia in which the appendix is located inside the herniated sac. Diagnosis of the condition is challenging and its treatment must be performed without delay. We present the case of a 75-year-old patient with a femoral hernia in which an appendix with signs of inflammation was found. An appendectomy followed by hernia repair was performed under an open preperitoneal approach according to Nyhus technique. The patient did not present any complications and was discharged on the second postoperative day. This type of hernia is often unexpected and its preoperative diagnosis is difficult to perform. In most cases the clinical picture is indistinguishable from a common incarcerated hernia. Contrast-enhanced CT is the most useful complementary test, although it is not as accurate as desirable, so the diagnosis is frequently found intraoperatively. There is a wide variety of surgical options and there is no consensus on the most appropriate one. The preperitoneal approach enables the performance of an appendectomy and subsequent hernia reparation. The use of prosthesis should be considered if there are no signs of perforation or abscess. De Garengeot’s hernia is a very rare entity. The diagnosis and subsequent surgical treatment must be early to prevent the disease progression. The preperitoneal approach should be considered as the first choice technique, as it allows the exploration of the herniated sac and the performance of surgical procedures on its content.