Rare Presentation of Necrotic Appendicitis and Small Bowel Obstruction in an Elderly Man: De Garengeot Hernia

De Garengeot hernia, characterized by the presence of the vermiform appendix within the femoral hernia sac, is a rare condition often diagnosed only intraoperatively. The incidence of acute appendicitis within a De Garengeot hernia is even more uncommon, and its clinical presentation may be atypical, making preoperative diagnosis difficult. This report describes the case of a 67-year-old male patient with multiple comorbidities, including an abdominal aortic aneurysm, who presented with right inguinal pain and bulging, culminating in the intraoperative diagnosis of a De Garengeot hernia with acute appendicitis and tip necrosis. The surgical approach involved appendectomy and hernia repair without mesh due to the risk of infection. The patient evolved favorably, highlighting the importance of high clinical suspicion and appropriate surgical management for this rare and potentially serious condition.