De Garengeot hernia: a systematic review

Area of Science:

• Surgery
• Gastroenterology
• Anatomy

Background:

• A De Garengeot hernia is a rare condition where the appendix is located within a femoral hernia.
• Despite numerous case reports since 1731, a comprehensive analysis of its presentation, diagnosis, management, and outcomes is lacking.

Purpose of the Study:

• To systematically review and analyze existing literature on De Garengeot hernias.
• To develop a classification system for De Garengeot hernias based on the appendix's gross appearance.

Main Methods:

• A systematic review was conducted using PubMed, Google Scholar, Embase, and Web of Science.
• Keywords included "De Garengeot hernia," "femoral appendicitis," "femoral hernia appendix," and "crural hernia appendix."
• A classification system was created based on the gross appearance of the appendix within the hernia.

Main Results:

• 222 cases were identified across 197 manuscripts, with most originating from Europe.
• The condition predominantly affects females (81.1%) with a mean age of 69.8 years.
• Common symptoms include groin bulge (82.4%) and tenderness (79.7%). Pre-operative diagnosis via imaging was only 31.5%.
• The appendix was most commonly congested/inflamed (44.1%). Complications occurred in 9.5% of cases, primarily surgical site infections.

Conclusions:

• De Garengeot hernias are rare and present with significant clinical heterogeneity.
• The developed classification system may aid in standardizing management and reducing complications.