本病例來源於ACR官網，翻譯分享僅供同仁參考學習。歡迎對翻譯做出指正指導，也歡迎有興趣同仁來一起參與病例翻譯討論交流
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.
發生於股疝中的闌尾炎破裂伴膿腫是急性闌尾炎的一種極其罕見的表現形式。蚓狀闌尾出現在股疝的疝囊中被稱為Garengeot疝，由Jacques de Garengeot在1731年首次描述，而首次報導的闌尾切除發生在5年後。它與Amyand疝截然不同，Amyand疝指的是闌尾在腹股溝疝的疝囊內。與腹股溝管較大的空間相比，股管的空間較小，因此人們認為股疝內容物更容易遭到嵌頓。
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.
股靜脈變扁平被認為是股疝在CT影像中的一個特殊徵象。重要的是，放射學醫師要能夠在術前準確診斷Garengeot疝，從而能夠實現恰當的手術治療。在一篇文獻綜述中，只有44%發生於股疝中的闌尾炎患者能夠得到正確的術前診斷。典型的臨床表現為絕經女性出現伴腫、痛的右側腹股溝腫塊。在我們這經手術證實的案例中，術者從右股管移出穿透性壞疽的闌尾同時清除小膿腫及修補股管。
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影像中去鑑別股疝，腹股溝直疝，腹股溝斜疝及閉孔疝。腹股溝直疝壓迫腹股溝管內容物及脂肪使其變成細半月形（「外側半月」徵）。腹股溝斜疝發生在起源於髂外動脈的腹壁下血管的外側。閉孔疝可發生於閉膜管存在缺損的時。閉膜管是一個位於閉孔膜上部的一個開口，閉孔血管和神經正常在此通過。這些重要的不同類別疾病需要通過放射科醫師來進行診斷從而能夠實現恰當的臨床管理及手術治療。