De Garengeot 疝

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双语病例

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Femoral hernia ruptured appendicitis withabscess is an extremely rare presentation of acute appendicitis. The presenceof a vermiform appendix in a femoral hernia sac, termed de Garengeot hernia,was first described in 1731 by Jacques de Garengeot 5 years before the first reportedappendectomy. It is a distinct entity from Amyand hernia, in which the appendix iswithin an inguinal hernia sac. It is thought that femoral hernia contents maybe more prone to incarceration due to the small space of the femoral canalcompared to the larger space of the inguinal canal.

发生于股疝中的阑尾炎破裂伴脓肿是急性阑尾炎的一种极其罕见的表现形式。蚓状阑尾出现在股疝的疝囊中被称为Garengeot疝，由Jacques de Garengeot在1731年首次描述，而首次报道的阑尾切除发生在5年后。它与Amyand疝截然不同，Amyand疝指的是阑尾在腹股沟疝的疝囊内。与腹股沟管较大的空间相比，股管的空间较小，因此人们认为股疝内容物更容易遭到嵌顿。

Flattening of the femoral vein isconsidered a specific sign of femoral hernia on CT imaging. It is importantthat the radiologist make the correct distinction of a de Garengeot herniaappendicitis preoperatively so that proper surgical management can be achieved.In a review of the literature, only 44% of cases of femoral hernia appendicitiswere correctly diagnosed by CT preoperatively. The classic clinicalpresentation is a postmenopausal woman with a painful, erythematous right groinmass. In our surgically proven case, a perforated gangrenous appendix wasremoved from the right femoral canal with debridement of a small abscess and afemoral herniorrhaphy was performed.

股静脉变扁平被认为是股疝在CT影像中的一个特殊征象。重要的是，放射学医师要能够在术前准确诊断Garengeot疝，从而能够实现恰当的手术治疗。在一篇文献综述中，只有44%发生于股疝中的阑尾炎患者能够得到正确的术前诊断。典型的临床表现为绝经女性出现伴肿、痛的右侧腹股沟肿块。在我们这经手术证实的案例中，术者从右股管移出穿透性坏疽的阑尾同时清除小脓肿及修补股管。

Recall how to differentiate a femoral hernia, direct inguinal hernia, indirect inguinal hernia, and obturator hernia on CT imaging. A direct inguinal hernia compresses the inguinal canal contents and fat into a thin lateral crescent ('lateral crescent' sign). Indirect inguinal hernia arises lateral to the course of the inferior epigastric vessels, which arise from the external iliac vessels. Obturator hernia can be seen when there is a defect in the obturator canal, which is an opening in the superior part of the obturator membrane through which the obturator vessels and nerve normally pass. These are important different entities to diagnose by the radiologist so that the appropriate clinical and surgical management can be achieved.

回想如何在CT影像中去鉴别股疝，腹股沟直疝，腹股沟斜疝及闭孔疝。腹股沟直疝压迫腹股沟管内容物及脂肪使其变成细半月形（“外侧半月”征）。腹股沟斜疝发生在起源于髂外动脉的腹壁下血管的外侧。闭孔疝可发生于闭膜管存在缺损的时。闭膜管是一个位于闭孔膜上部的一个开口，闭孔血管和神经正常在此通过。这些重要的不同类别疾病需要通过放射科医师来进行诊断从而能够实现恰当的临床管理及手术治疗。