Introduction De Garengeot hernia is a appendix within the femoral hernia is a rare entity which was first described by Rene Jacques de Garengeot in 1700s. The purpose of this case report is to discuss presentation, diagnosis and surgical approaches regarding de Garengeot’s hernia as there are different operative approaches of management for this rare entity. Presentation We present a case of 80-year-old lady with De Garengeot hernia with strangulated appendicitis within the hernia sac. The diagnosis was made preoperatively with computed tomography and managed with open right hernia repair and appendicectomy using McEvedy approach. There was no postoperative complication and patient was discharged after 24 hours. Discussion The presentation of De Garengeot hernia is non-specific. There are various approaches to De Garengeot hernia including open, laparoscopic (both transabdominal preperitoneal hernia repair (TAPP) and total extraperitoneal procedure (TEP)) and laparotomy depending on the presentation and complications from the hernia. In case of emergency with strangulation and necrosis, open McEvedy approach is safe and sufficient to perform both hernia repair and appendicectomy. If there is expertise available, TAPP to repair femoral hernia followed by laparoscopic appendicectomy is emerging approach and safe alternative. Conclusion The gold standard surgical approach for De Garengeot hernia is unclear due to its rare entity and non-specific presentation. Further systemic review and outcome of patients post-operatively using different approaches should be directed to determine the first-line surgical approach for patients presenting with this condition for future surgeons.