Degarengeot’s Hernia: Laparoscopic Reduction, Repair & Resection of an Incarcerated Appendiceal Mucocele

Overview:
Our patient is a 69 year old female who presented for evaluation of rightthigh mass. Initially believed to represent a soft tissue malignancy, the mass waseventually found to be a femoral hernia containing incarcerated appendix. She underwent successful simultaneous laparoscopic TAPP herniorrhaphy and appendectomy.

Background:
Femoral hernia containing the appendix was first described in 1731 by the French surgeon de Garengeot. Overall femoral hernias constitute roughly 1% of all hernias and appendiceal incarceration is exceedingly rare. Review of the current literature reveals only one description of a laparoscopic approach to this problem.

Case History:
The patient initially noticed a right-sided, mobile, infra-inguinal groin bulge and tenderness after lifting a case of wine. An ultrasound evaluation showed a cystic mass which was aspirated, returning mucin. However, follow-up ultrasound revealed a residual solid structure which was subsequently characterized as appendix by MRI and CT imaging. Given the need for both herniorrhaphy and appendectomy in the setting of a presumed mucocele, a combined laparoscopic approach was felt to be reasonable. With the patient in the supine position, 2 12 mm ports and 1 5mm port were placed in the infraumbilical and high bilateral lower quadrant positions. The appendix was reduced from the hernia using slotted graspers without injury or spillage of mucin. The peritoneum was incised and the hernia sac reduced to allow for completion of a traditional TAPP hernia repair with the polypropylene mesh from the hernia repair completely covered by peritoneum and tacked in place. A laparoscopic appendectomy was then performed using a stapled technique. The Patient tolerated the procedure well, was discharged home the day of surgery and has returned to full activity without complication. At one year follow-up, she is free of recurrence or infection. We believe this is the first report of a laparoscopic approach to a chronically incarcerated de Garengeot’s hernia. Our patient also provides an excellent illustration of the utility of laparoscopy in the repair of complex hernias.

Session: Video Channel

Program Number: V056