Incarcerated Femoral Hernia

Explanation

The radiograph and the vomiting establish a small bowel obstruction, and the tender irreducible groin lump identifies the cause as an incarcerated hernia. The decisive clinical detail is the position of the swelling relative to the pubic tubercle. A femoral hernia passes through the femoral canal, medial to the femoral vein and beneath the inguinal ligament, so its neck lies inferior and lateral to the pubic tubercle. Inguinal hernias, whether direct or indirect, emerge through the superficial inguinal ring above the inguinal ligament and therefore lie superior and medial to the tubercle. The demographic profile reinforces the diagnosis: femoral hernias are considerably more common in women, particularly older multiparous women, because pregnancy and a wider female pelvis enlarge the femoral canal. The femoral canal is a narrow rigid ring bounded by the lacunar ligament medially and the inguinal ligament anteriorly, which is why femoral hernias have the highest rate of incarceration and strangulation of any groin hernia and often present, as here, with bowel obstruction. The obstruction may occasionally involve only part of the bowel circumference, a Richter hernia, in which case gangrene can occur without complete obstruction. A metastatic node is firm and does not cause bowel obstruction. Treatment is urgent operative reduction and repair with assessment of bowel viability.

Why each option

A.

A direct inguinal hernia emerges above the inguinal ligament, superior and medial to the pubic tubercle, has a wide neck, and rarely obstructs.

B.

A metastatic lymph node is a firm fixed mass and cannot itself cause mechanical small bowel obstruction.

C.

An indirect inguinal hernia also lies superior and medial to the pubic tubercle and often descends into the labium, which does not match the described location.

D.

Correct. A tender irreducible groin lump below and lateral to the pubic tubercle causing small bowel obstruction in an older multiparous woman is an incarcerated femoral hernia.

More Surgery questions

• Achalasia Management
• Acute Limb Ischemia and Venous Thromboembolism
• Bethesda IV Follicular Neoplasm Management
• Diagnosis of Inhalation Injury
• Disseminated Intravascular Coagulation in Sepsis
• Emergency Decompression of Tension Pneumothorax