A combined Richter's and de Garengeot's hernia.

Introduction: de Garengeot's hernia is very rare. Richter's hernia is responsible for 10% of acute strangulated hernias.

Presentation Of Case: A 91-year-old woman with three days of abdominal distention was found on computed tomogram to have an incarcerated femoral hernia. Operation revealed a de Garengeot's hernia combined with a Richter's hernia of small bowel. Primary repair was performed along with appendectomy.

Discussion: We discuss these rare hernias, not previously reported in combination, and options for management.

Conclusion: Combined de Garengeot's and Richter's hernias are rare, represent a significant diagnostic challenge, and should be repaired urgently to prevent ischemic bowel, or limit contamination if ischemia is already present. Use of computed tomography will likely lead to increased pre-operative diagnosis of this rare entity.