Discharge diagnosis: obstructed right femoral hernia causing intestinal

obstruction.

Femoral hernia (text)

Compared to the direct and indirect inguinal hernias, femoral hernia is rare and more than 80%

of the cases seen are among women. Many of them have born children. It has to be noted that even among woman inguinal hernias are more common than femoral hernia. The femoral structures leave the abdomen and enter the thigh below the inguinal ligament

through the femoral canal. The common site of femoral hernia is through the femoral ring located medial to the femoral vein. The femoral canal is narrowed at the neck and once omentum or intestine herniates through this narrow neck, chances of incarceration obstruction and strangulation become more likely.

Diagnosis

In the early stages a small reducible lump present below the inguinal ligament in the femoral area may not cause significant symptoms to draw attention. However, as more contents get into the sac, the neck being narrow, the swelling gets more prominent leading to discomfort and pain. More often femoral hernias are seen for the first time in an emergency because of symptoms of irreducibility leading to obstruction and strangulation, very few cases are picked up electively and operated. Sometimes clinical and radiological signs of intestinal obstruction may be present at this stage. The differential diagnosis of a small lump in this area would include other types of inguinal hernia, varicocele, undescended testes, hydrocele of the cord and prominent lymphadenopathy. Most often the patient is able to relate to the swelling with or without symptoms. However, in obese and elderly patients, the symptoms are frequently over looked till an emergency situation arises as the case cited above. A rare type of femoral hernia called "Richter's Hernia" involves the inclusion in the sac only part of the antimesenteric side of the small intestine. When this happens the obstruction is not complete for some time and it may not even show as a palpable lump in the groin. If the obstruction continues the intestinal wall may necrose and perforate. Very rarely patients receive abdominal exploration only to find out that a small knuckle of intestine is caught in a Richert's femoral hernia causing obstruction, strangulation and at times perforation.