A Case Report of a Perforated De Garengeot Hernia.

De Garengeot hernias are defined as the presence of an incarcerated appendix within a femoral hernia. Patients typically present with a painful and irreducible groin bulge, often without classic signs of appendicitis, and ambiguous imaging, making preoperative diagnosis difficult. Further, with no standardized management strategy, treatment is based on case presentation and surgeon preference. Here, we report a rare case of an intraoperatively diagnosed perforated De Garengeot hernia and how it was successfully managed.  A 55-year-old female patient presented with a three-week history of a progressively worsening, erythematous, severely tender right groin bulge with mild abdominal pain. She was febrile, and the physical exam demonstrated a nonreducible groin mass without any peritoneal signs. CT abdomen/pelvis and ultrasound of the right groin suggested an incarcerated femoral hernia likely composed of strangulated fat with overlying cellulitis. The patient was taken for robotic femoral hernia repair, during which a De Garengeot hernia was identified. The case continued with a robotic appendectomy with subsequent incision and removal of the appendix over the femoral canal. Due to significant contamination, hernia repair with mesh was deferred. A Penrose drain was placed, and the patient recovered uneventfully with plans for future repair.  De Garengeot hernias are exceptionally rare pathologies, often presenting with nonspecific symptoms and inconclusive imaging. Thus, diagnosis is difficult and often done intraoperatively. This case emphasizes the need to maintain a high clinical suspicion and an appropriate readiness to convert strategy if discovered.