The presence of an incarcerated vermiform appendix within a femoral hernia 
defect, a De Garengeot hernia, is distinctly different than an inguinal hernia 
containing the appendix, an Amyand hernia. The De Garengeot hernia is a rare 
finding with few reported cases. We present a 35-year-old female with a painful 
groin mass palpable below the inguinal ligament. An ultrasound of the groin 
revealed a thin-walled fluid collection medial to the femoral vessels. No 
additional imaging at the time was obtained. Intra-operatively, the patient was 
found to have her distal appendix incarcerated within the transected hernia sac 
thus altering the planned surgical procedure. We present a unique operative 
approach for managing a De Garengeot hernia.