Case Report: Incarcerated femoral hernia of the appendix with incidental discovery of goblet cell carcinoma.

BACKGROUND: Femoral hernias are relatively uncommon in clinical practice but are of considerable clinical significance because they are associated with a higher risk of strangulation happening. Even rarer is the discovery of the appendix within the hernia sac, a condition known as De Garengeot hernia, and within this already highly unlikely scenario, having a tumor within the hernia is exceedingly rare. Among such cases, Goblet cell carcinoma (GCC) represents an incredibly rare occurrence.

CASE SUMMARY: We present the case of an 83-year-old man who had undergone transabdominal preperitoneal (TAPP) repair for an incarcerated femoral hernia. During the operation, the incarcerated part was found to be the tip of the appendix, which made it necessary to perform a laparoscopic appendectomy (LA). Subsequent histopathological examination revealed GCC invading the muscularis propria, and given the patient's advanced age, significant comorbidities, and the family's stated preference, a right hemicolectomy was not performed. At the 1-year follow-up, computed tomography (CT) and tumor markers indicated no sign of recurrence.

CONCLUSION: For older individuals with co-existing health conditions and those at the early stage of GCC, a cautious management approach backed by active monitoring might be a sensible option following a thorough evaluation of risks and benefits, and this instance provides a realistic view on dealing with such rare and medically complex scenarios.