Interesting case Abdominal 32

Principal Diagnosis:

De Garengeot’s hernia with acute appendicitis.

Salient findings:  

• Moderate sized fat and fluid containing hernia located lateral to the pubic tubercle.
  
• Narrow-funnelled hernia neck medial to the femoral vein with mild mass effect upon the traversing femoral vein. 
• Features in keeping with right sided femoral hernia.  
• In addition, the tip of the appendix lies within the superior part of the hernia and demonstrates enhancement and focal tip dilation with adjacent fat stranding. 
• Inflammatory fat stranding at the hernia neck with a few small appendicoliths proximally in the appendiceal lumen.   
• Features in keeping with De Garengeot's hernia; an appendix contained within a femoral hernia with, in this case, resultant acute appendicitis.  
• This can be contrasted with an Amyand hernia, where the appendix lies within an inguinal hernia.   

Other important findings:

A 12mm cystic appearing lesion in the proximal pancreatic body which may represent an IPMN involving main or side branch of the duct. 

Learning points:  

1. Differentiating features between inguinal and femoral hernias
2. Important eponymous names for involvement of other structures. In addition to Amyand and De Garengeot’s herniae involving the appendix, other examples include: 

• Littré hernia: Meckel’s diverticulum within an abdominal hernia, usually inguinal. 
• Richter’s hernia: Only a portion of the antimesenteric wall of the bowel involved within the hernia so less likely to result in complete intestinal obstruction however carries a high risk of bowel wall gangrene.