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Right Sided Obstructed Femoral Hernia Causing Small Bowel Obstruction

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Right Sided Obstructed Femoral Hernia Causing Small Bowel Obstruction Right Sided Obstructed Femoral Hernia Causing Small Bowel Obstruction CASE REPORT Right Sided Obstructed Femoral Hernia Causing Small Bowel Obstruction 1 2 3 4 5* A .M. Rajyaguru , B.V. Vaishnani , J. G. Bhatt , I. A. Juneja , Milap Shah 1,2,3 4 5 rd M.S. FIAGES, FMAS, M.S, 2 Year Resident, P. D. U. Govt. Medical College & Hospital, Rajkot ABSTRACT We describe the case of 55 year female with swelling and pain in right inguinal region associated with abdominal distension and vomiting.Abdominal x-rays(upright) were performed which was indicative of small bowel obstruction Ultrasound was suggestive of Right sided inguinal region showing gap defect with herniation of small bowel and omentum non reducible and absence of cough impulse with dilated small bowel . S/O Right sided inguinal hernia with developing small bowel obstruction .CECT Abdomen was showing evidence of dilatation of small bowel loop with air fluid levels within it with max diameter of 32mm. S/O Right sided inguinal hernia 19mm gap defect with small bowel obstruction Key words: Femoral Hernia, Small Bowel Obstruction, Emergency lapatotomy, Pre Peritoneal Meshplasty. INTRODUCTION asymptomatic before 1 year then patient Femoral hernias are elusive conditions that observed small swelling over right despite having life-threatening inguinal region. Initially swelling was of complications are often undiagnosed in small size then gradually its size increased asymptomatic patients . They are less since last 9 months then swelling become common than inguinal hernias and occur painful suddenly and vomiting with more frequently in females . Anatomically, distension of abdomen occurred..All they represent herniations of the peritoneal baseline blood investigations were normal. sac through the femoral ring into the Flat and upright abdominal x-rays were femoral canal, lying postero-inferiorly to performed which did not reveal any free the inguinal ligament. The hernia sac air under the diaphragm. However the commonly contains small bowel or pattern of bowel gas was indicative of omentum, but uncommon cases have been small bowel obstruction. Ultrasound was reported, where the herniating structures suggestive of Right sided inguinal region were caecum, appendix, colon, Meckel’s showing gap defect with herniation of diverticulum, ovaries, testes, stomach and small bowel and omentum non reducible kidneys . and absence of cough impulse with dilated CASE HISTORY small bowel . S/O Right sided inguinal A 55 years old hindu female patient named hernia with developing small bowel Jinabai Danabhai working as a labourer obstruction .CECT Abdomen was showing coming from a lower socioeconomic class evidence of dilatation of small bowel loop residing at Wankaner was admitted in with air fluid levels within it with max P.D.U. Hospital with the complaint of diameter of 32mm. S/O Right sided swelling and pain in the right inguinal inguinal hernia 19mm gap defect with region. Patient was relatively small bowel obstruction. So, emergency exploration and reduction of obstructed *Corresponding Author: femoral hernia and pre peritoneal prolene Dr. Milap Shah meshplasty done with size (6*11) cms . 4th Floor, New OPD Building Post operative period was uneventful. P.D.U. Govt. Medical College & Hospital, Patient was started orally on 3rd post op th Rajkot - 360001 day and discharged on 4 post op day E-mail: [email protected] with no complications on follow up Contact No: 8141200532 examination. 175 Int J Res Med. 2016; 5(2); 175-176 e ISSN:2320-2742 p ISSN: 2320-2734 Right Sided Obstructed Femoral Hernia Causing Small Bowel Obstruction DISCUSSION transabdominalpreperitonoeal approach A femoral hernia is an extension of a (TAPP). Femoral hernia is a rare cause of viscous in the course of the femoral canal gastrointestinal obstruction and is at high and exit via the saphenous opening due to risk of strangulation due to the a defect in the femoral ring. It is the third narrow femoral canaland femoral ring commonest hernia and twenty percent CONCLUSION happening in women versus 5% in men. Obstructed femoral hernia of the small This hernia is more common on the right bowel is rare and the general surgeon side of multi-parous old women. The should be familiar with femoral hernia as a femoral ring is bordered anteriorly by the bowel obstruction source. inguinal ligament, posteriorly by the iliopectineal ligament, medially by the Figure- 1 CECT abdomen lacunar ligament, and laterally by the femoral vessels. The narrow femoral canal and rigid femoral ring are the main cause of bowel incarceration, strangulation and bowel resection which has been shown to have increased mortality and morbidity . The etiology is a controversial topic due to Figure-2a Intra operative findings lack of data in condition of congenital versus acquired hypothesis. The acquired theory is widely accepted with a general clarification of increased intra-abdominal pressure from chronic bronchitis and constipation leading to stretching of the femoral ring from a dilated femoral vein . REFERENCES Clinical manifestation possibly the 1. DahlstrandU,Wollert S, Nordin P, sensation of a bulge in the groin. Colicky Sandblom G, Gunnarsson U. Emergency abdominal pain and vomiting may femoral hernia repair: a study based on a persevere due to incarceration and national register. Ann Surg. obstruction or strangulation of small 2009;249(4):672-6. bowel.On examination, the hernia can be 2. Akrami M, GhaeiniHesarooeih A, Barfei recognized below and lateral to the pubic M, Zangouri V, Alborzi Z. Clinical tubercle; it may be generally irreducible Characteristics of Bowel Obstruction in and may be tender . A femoral hernia Southern Iran; Results of a Single Center needs to be distinguished clinically from Experience. Bull Emerg Trauma. other groin lump for example inguinal 2015;3(1):22-6. hernia, saphenavaricocel, groin 3. HachisukaT.Femoralhernia repair. SurgClin lymphadenopathy, lipoma, femoral artery North Am. 2003;83(5):1189-205. aneurysm, and psoas muscle abscess. 4. Kochupapy RT, Ranganathan G, Dias S, Generally diagnosis is clinically; but, Shanahan D. Aetiology of femoral hernias imaging techniques such as ultrasound, revisited: bilateral femoral hernia in a CT, MRI or diagnostic laparoscopy may young male (two cases). Ann R CollSurg be useful. The protruded viscous is Engl. 2013;95(1):e14-6. strangulated and undergoes a tissue 5. Rogers FA. Strangulated femoral hernia: a necrosis in the femoral hernias more than review of 170 cases. Ann Surg. other types of hernia.When 1959;149(1):9-20. diagnosed, femoral hernias should be 6. Rosenberg J, Bisgaard T, Kehlet H, Wara electively repaired as soon as possible.The P, Asmussen T, Juul P, et al. Danish Hernia golden standard operative management to Database recommendations for the repair the defect are using either the management of inguinal and femoral hernia McEvedy operation or totally in adults. Dan Med Bull. extraperitoneal approach (TEP) or the 2011;58(2):C4243. 176 Int J Res Med. 2016; 5(2); 175-176 e ISSN:2320-2742 p ISSN: 2320-2734 .
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