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JMSCR Vol||06||Issue||12||Page 746-748||December 2018 JMSCR Vol||06||Issue||12||Page 746-748||December 2018 www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.121 Small Bowel Obstruction Secondary to Femoral Hernia: Case Report and Review of the Literature Authors Dr Dharmendra Kumar1*, Dr Mohan Kumar K2, Dr Prakash M3, Dr Spurthi4 Department of General Surgery, Sri Devaraj URS Medical College, Kolar, Karnataka, India Abstract Femoral hernias account for 3% of groin hernias, and are more common in women, and are more appropriate to present with strangulation and require emergency surgery. Approximately 50% of men with a femoral hernia will have an associated inguinal hernia whereas this relationship occurs in only 2% of women. In this article we report a case of strangulated femoral hernia that presented with features of small bowel obstruction and underwent emergency laprotomy and resection and end to end anastomosis and hernia repair. Postoperative course was uneventful and the patient was doing well. Strangulated femoral hernia of small bowel is rare. Keywords: Femoral Hernia, Small Bowel Obstruction, Strangulation. Introduction size of the femoral canal and the risk of hernia. In A femoral hernia is an extension of a viscous in old age the femoral defect increases and femoral the course of the femoral canal and exit via the hernia is commonly seen in low weight elderly saphenous opening due to a defect in the femoral females [3}. ring. It is the third commonest hernia and twenty The acquired theory is widely accepted with a percent happening in women versus 5% in men. general clarification of increased intra-abdominal This hernia is more common on the right side of pressure from chronic bronchitis and constipation multiparous old women. The predominance of leading to stretching of the femoral ring from a right sided femoral hernia is thought to be caused dilated femoral vein. Clinical manifestation by tamponading effect of the sigmoid colon on the possibly the sensation of a bulge in the groin. left side [2]. Strangulation is the most serious Colicky abdominal pain and vomiting may complication of hernia and femoral hernia has the persevere due to incarceration and obstruction or highest rate of strangulation (15% to 20%). The strangulation of small bowel. On examination, the walls of a femoral hernia are the femoralvein hernia can be recognized below and lateral to the laterally,the inguinal ligament anteriorly, the pubic tubercle; it may be generally irreducible and pelvic bone covered by the ileopectineal ligament may be tender. A femoral hernia needs to be (Astley Cooper’s) posteriorly and the lacunar distinguished clinically from other groin lump for ligament (Gimbernat’s) medially. The female example inguinal hernia, saphenavaricocele, groin pelvis has a different to the male, increasing the lymphadenopathy, lipoma, femoral artery Dr Dharmendra Kumar et al JMSCR Volume 06 Issue 12 December 2018 Page 746 JMSCR Vol||06||Issue||12||Page 746-748||December 2018 aneurysm, and psoas muscle abscess. Generally groin region); mild generalized tenderness, there diagnosis is clinically; but, imaging techniques were no clinical signs of peritonitis. All laboratory such as ultrasound, CT, MRI or diagnostic tests were unrevealing. The case is presented laparoscopy may be useful. The protruded viscous clearly with a coronal computed tomography (CT) is strangulated and undergoes a tissue necrosis in (Fig.4 CT showing bowel in the right femoral the femoral hernias more than other types of canal.) and abdominal radiograph images. A hernia. When diagnosed, femoral hernias should hernia occurring medial to the femoral vessels and be electively repaired as soon as possible. The below the inguinal ligament was consistent with a golden standard operative management to repair femoral hernia. The patient underwent emergency the defect is using either the McEvedy operation laparotomy for resection of obstructed bowel loop or totally extraperitoneal approach (TEP) or the and repair of the femoral hernia (Fig 2 & 3Per- transabdominal preperitonoeal approach operative findings). There was incarceration of (TAPP).This report describes a case of a small bowel (short segment) about 100 cm to strangulated small bowel in right femoral canal ileocecal valve in right femoral canal with hernia. necrosis and some degree of inflammation. There was fluid field, distended small bowel loop Case Presentation proximal to site of incarceration. Strangulated A 65 year old woman presented to our emergency small bowel in right femoral canal was released department with abdominal pain, nausea and and then femoral canal defect was repair via intra- vomiting since 3 days prior to admission. On abdominal approach with PDS sutures and figure physical examination, she appeared to be ill, with of eight manner. The postoperative course was diffuse abdominal distention (Fig 1 Lump in right unremarkable. Images from left to right showing 1) Lump in right groin region, 2,3)Per-operative findings, 4) CT showing bowel in the right femoral canal. Dr Dharmendra Kumar et al JMSCR Volume 06 Issue 12 December 2018 Page 747 JMSCR Vol||06||Issue||12||Page 746-748||December 2018 Discussion References Strangulated femoral hernia is not common event. 1. Bailey and Love’s Short Practice of Rogers5 reported a review on 170 cases of Surgery 26th edition. strangulated femoral hernia and its complications. 2. Sabiston Textbook of Surgery First South Two study report strangulated bilateral femoral Asia Edition hernia[6,7] This hernia could include: stomach, 3. Akrami M, Karami MY, Zangouri V, omentum, colon, small intestines (the partially Deilami I, Maalhagh M. Small Bowel strangulated small intestine wall called Richter’s Obstruction Secondary to Femoral Hernia; hernia), the appendix (De Garengeot hernia)9, Case Report and Review of the Literarture. urinary bladder, fallopian tube and ectopic testis8. Bull Emerg Trauma 2016; 4:51-53. The differential diagnosis of femoral hernia 4. Porter DJ, Kiljenny J, Vujovic Z. An includes inguinal lymph nodes, direct and indirect Unusual Case of Femoral Hernia. J Med inguinal hernia, and hydrocele of the cord or canal Cases 2016; 7:213-14. of Nuck, the greatest saphenous vein varices, 5. Rogers FA. Strangulated femoral hernia: a femoral artery aneurysm, ectopic testis and psoas review of 170 cases. Ann Surg. 1959;149 abscess10. (1):9–20. Strangulation of femoral hernia is seriously life 6. Nikolopoulos I, Oderuth E, Ntakomyti E, threatening event. The most important symptom is Kald B. Intestinal Obstruction due to typically a painful bulge, placed on the medial Bilateral Strangulated Femoral Hernias. aspect of the thigh, regularly not easy to palpate in Case Rep Surg. 2014;2014:195736 overweight patients. In the clinical case mentioned 7. Jones JD. Bilateral Strangulated Femoral above, the patient presented symptoms unique for Hernia. Br Med J. 1942;1(4244) the gastrointestinal obstruction (constipation and 8. Baum RK, Olch IY. Meckel's obstipation). In this case first we approached by diverticulum incarcerated in a femoral inguinal approach (Lotheissein) and then made hernia. Calif Med. 1958;88(5):386–8. midline incision for the bowel resection. 9. Rebai W, Hentati H, Makni A, Ksontini R, The other surgery for the femoral hernia is (1) Chebbi F, Ftiriche F, et al. Appendicitis in Low approach (Lockwood) is suitable when there strangulated femoral hernia: a case is no risk for bowel resection, (2) High approach report. Tunis Med. 2010;88(3):193–5. (McEvedy) is ideal in the emergency situation 10. Alzaraa A. Unusual contents of the where the risk of bowel resection is high, and (3) femoral hernia. ISRN Obstet Gynecol. Laproscopic approach which includes TEP and 2011;2011:717924. TAPP. This case report strangulated femoral hernia reinforces the value of femoral hernia because of their high risk of incarceration and strangulation. Conclusion In conclusion, strangulated femoral hernia of the small bowel is rare and the general surgeon should be familiar with femoral hernia as a bowel obstruction source. Dr Dharmendra Kumar et al JMSCR Volume 06 Issue 12 December 2018 Page 748 .
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