De Garengeot's Hernia Mimicking Acute Coronary Syndrome and Complicated by Acute Iliofemoral Deep Vein Thrombosis: A Case Report.

De Garengeot's hernia (DGH) is a rare condition defined by the presence of the vermiform appendix within a femoral hernia sac. We report the case of a 65-year-old female smoker on hormone replacement therapy (HRT) with a known history of a right groin hernia who presented with epigastric pain, nausea, and vomiting. Due to elevated troponin levels, she was initially admitted to the Coronary Care Unit (CCU) for suspected acute coronary syndrome (ACS) and started on dual antiplatelet therapy and full anticoagulation. Following a four-day diagnostic workup that ruled out ACS, a targeted physical examination and bedside ultrasound identified an incarcerated femoral hernia. A subsequent contrast-enhanced computed tomography (CT) scan confirmed an incarcerated DGH associated with a concurrent, mechanical deep vein thrombosis (DVT) of the right external iliac and common femoral veins. Despite recent antiplatelet and anticoagulant exposure, the patient underwent an urgent appendectomy and an anterior mesh-based femoral hernia repair with an uneventful recovery.