General surgery, quality improvement, evidence-based medicine, and medical education.

Sonal Kapoor is a dedicated and highly motivated medical professional currently serving as a Junior Clinical Fellow in General Surgery at Salford Royal Hospital, United Kingdom. She completed her MBBS from Bareilly International University in December 2022 and has since demonstrated a strong commitment to advancing her clinical and academic expertise. She achieved Membership of the Royal College of Surgeons (MRCS) from RCSEd in September 2024 and further enhanced her academic profile with a Postgraduate Certification in Medical Education from the University of Warwick in September 2025. She is registered with the General Medical Council (GMC), UK, since September 2023. Miss Kapoor has gained diverse clinical experience across multiple specialties. Her previous roles include Junior Clinical Fellow positions in Renal Medicine and Transplantation, and Breast Surgery at Barts Health NHS Trust, as well as Junior Resident roles in Burns, Plastics and Reconstructive Surgery, and Anaesthesiology and Critical Care at ABVIMS Dr. RML Hospital, India. Alongside her clinical practice, she has actively contributed to research, serving as the lead for a quality improvement project, and as a co-author and first author for a systematic review and a meta-analysis study, respectively, both currently under journal review. She has also completed Good Clinical Practice (NIHR) training in April 2025, reflecting her strong foundation in clinical research standards. Miss Kapoor continues to pursue excellence in surgical practice, education, and research, with a keen interest in contributing to evidence-based medicine and improving patient care outcomes. Reference: De Garengeot’s Hernia: a Rare Differential for a Groin Lump Introduction A femoral hernia is a rare type of groin hernia accounting for less than 5% cases1, but more likely to present with acute complications, with a higher incidence in older female patients2. The presence of the vermiform appendix within the femoral hernia, eponymously known as De Garengeot’s hernia, occurs in only 0.5% to 5% of all femoral hernia cases3. We present a case where a delayed diagnosis occurred due to contradictory imaging and clinical findings during the assessment of a groin lump. Case Presentation This case report describes a 70-year-old female with right sided groin swelling and pain for 2 months. Initially suspected to be an inguinal hernia by her GP, an ultrasound scan was performed suggestive of an inguinal heterogenous mass. This led to a 2-week wait referral to the haem-oncology department for further investigation. An MRI scan was done which showed an incarcerated femoral hernia with strangulated fat and possible lymph node(Figure:1). This workup took nearly 2 months before she was finally reviewed by the General Surgery team and underwent an emergency groin exploration. Intraoperative findings included incarceration of the vermiform appendix with sealed perforation of the tip within the hernial sac (Figure:2), and an open femoral hernia repair with appendectomy was performed. Discussion This case report not only describes a rare case of complicated De Garengeot’s hernia, but it also highlights the importance of thorough clinical examination and decision-making based on clinical judgement, as imaging alone can be misleading4. The presence of the appendix within a femoral hernia is an uncommon finding which may lead to unusual appearance on conventional ultrasound leading to diagnostic uncertainty and delays in management5. In this case, an initial clinical impression of a groin hernia which was non-reducible should prompt more urgent surgical assessment. Instead, the diagnostic process was prolonged which resulted in clinical deterioration and progression to perforation of the appendix incarcerated within the hernial sac. Acknowledgements / Ethical Considerations Patient Consent: Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.