Femoral Hernia with a Twist

In England, there were 4500 cases of femoral hernia for the year 2005-2006, accounting for 3.5% of all herniae [1]. The femoral hernial sac contents may be varied: preperitoneal fat, omentum, small bowel, or colon. In rare instances, the appendix can be found in the hernial sac, a reported incidence of 0.8%. Whether inflamed or not, the finding of vermiform appendix inside a hernia sac is known as Amyand’s Hernia, and it classically refers to an inguinal hernia. Claudius Amyand (1681–1740), a French refugee in England, was one of the leading surgeons of his day; and held the accolade of being surgeon to George II of England. In 1735 he was the first to note the presence of a perforated appendix within the inguinal hernia sac in an eleven-year-old boy, and he subsequently performed a successful appendicectomy(Hutchinson, 1993; Franko and Sulkowki, 2002). Acute appendicitis in a femoral hernia is a rare, potentially serious complication. The presence of a vermiform appendix in a femoral hernia sac is termed De Garengeot hernia after Rene Jacques Croissant de Garengeot, an 18th century Parisian surgeon, who is quoted in the literature as the first to describe an appendix in a femoral hernia sac. It presents as an incarcerated or strangulated hernia, and the surgical management is different for the two conditions. Prompt surgery is needed to avoid complications. Awareness of this condition may help to avoid delay in management. We report a case of a patient with an acute appendicitis in a right femoral hernia presenting with a painful groin mass. 2. Case Study