Question:

CT findings suggestive of an incarcerated appendix include:
1. engorged mesoappendix with fat stranding
2. free fluid
3. hernia sac >2cm
4. intramural gas
5. regional adenopathy





Answer:

The correct answers for the question "CT findings suggestive of an incarcerated appendix include:" are:

1. engorged mesoappendix with fat stranding

2. free fluid

4. intramural gas



Explanation
1. CT findings include free fluid, fat stranding, free gas or intramural gas. [Reported CT findings in surgically proven cases of incarcerated de Garengeot hernia include free fluid within the hernial sac, an engorged mesoappendix with associated fat stranding, and extraluminal or intramural gas.]

2. Free fluid is a sign of incarceration or inflammation, and is also non-specific sign of perforation. [While findings such as free fluid within the hernia sac or peri-appendiceal stranding are associated with appendiceal inflammation [13], they are less reliable indicators of perforation, as demonstrated by the case presented.]

3. Hernia sac size is independent of risk of inflammation, however the small size of the femoral canal makes femoral hernias more likely to incarcerate than inguinal. [Hernial strangulation, which is more common in femoral than inguinal hernias due to the narrowness of the femoral ring, often isolates infection and inflammation within the sac, resulting in localised symptoms only.]

4. Intramural gas is indicative of ischaemia, secondary to incarceration. [Reported CT findings in surgically proven cases of incarcerated de Garengeot hernia include free fluid within the hernial sac, an engorged mesoappendix with associated fat stranding, and extraluminal or intramural gas.]

5. Adenopathy may be a non-specific sign of regional inflammation, but itself does not suggest incarceration. [Reported CT findings in surgically proven cases of incarcerated de Garengeot hernia include free fluid within the hernial sac, an engorged mesoappendix with associated fat stranding, and extraluminal or intramural gas.]



From the manuscript:
The French and their hernias: Prospective radiological differentiation of de Garengeot from other groin hernias
Radiology Case. 2013 Apr; 7(4):16-21


This article belongs to the GI section.




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From the manuscript

The French and their hernias: Prospective radiological differentiation of de Garengeot from other groin hernias

Free full text article: The French and their hernias:  Prospective radiological differentiation of de Garengeot from other groin hernias

Abstract
A femoral hernia containing an appendix, known as de Garengeot hernia, is an uncommon and potentially confusing presentation. Prompt differentiation of this condition from other groin hernias in an acute setting will influence management and reduce morbidity. Computed Tomography (CT) should be performed in all suspected cases and an awareness of likely CT findings can facilitate rapid pre-operative diagnosis. Despite this, we present only the fourth published case of prospective CT diagnosis of de Garengeot hernia.






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