A combined Richter's and de Garengeot's hernia

de Garengeot's hernia is very rare. Richter's hernia is responsible for 10% of acute strangulated hernias.

A 91-year-old woman with three days of abdominal distention was found on computed tomogram to have an incarcerated femoral hernia. Operation revealed a de Garengeot's hernia combined with a Richter's hernia of small bowel. Primary repair was performed along with appendectomy.

We discuss these rare hernias, not previously reported in combination, and options for management.

Combined de Garengeot's and Richter's hernias are rare, represent a significant diagnostic challenge, and should be repaired urgently to prevent ischemic bowel, or limit contamination if ischemia is already present. Use of computed tomography will likely lead to increased pre-operative diagnosis of this rare entity.