What are the clinical assessment findings for an obstructed femoral hernia?

From the Guidelines

Clinical assessment findings for an obstructed femoral hernia include a painful, tender, irreducible lump located below the inguinal ligament and lateral to the pubic tubercle, with severe localized pain, nausea, vomiting, and abdominal distention, and require immediate emergency surgical intervention to prevent bowel ischemia and necrosis, as supported by the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1. The clinical presentation of an obstructed femoral hernia can vary, but common findings include:

• A painful, tender, irreducible lump located below the inguinal ligament and lateral to the pubic tubercle
• Severe localized pain that may have developed suddenly
• Nausea, vomiting, and abdominal distention if bowel obstruction has occurred
• A firm and tense hernia that is extremely painful to attempt to reduce
• Erythematous skin overlying the hernia if strangulation has begun
• Hyperactive or absent bowel sounds
• A history of constipation or obstipation
• A previously reducible lump that has become painful and fixed
• Fever, tachycardia, and signs of sepsis suggesting strangulation with tissue necrosis The diagnosis of an obstructed femoral hernia should be prompt, as it has a high risk of strangulation, and emergency surgical intervention is required to prevent bowel ischemia and necrosis, as recommended by the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1. Systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, serum creatinine phosphokinase (CPK), and D-dimer levels are predictive of bowel strangulation, and should be considered in the diagnostic workup of an obstructed femoral hernia 1. Digital rectal examination and abdominal examination should be performed to assess for other causes of acute abdomen, and to confirm the diagnosis of an obstructed femoral hernia. The clinical assessment findings for an obstructed femoral hernia are critical in determining the need for emergency surgical intervention, and should be prioritized to prevent morbidity and mortality, as supported by the study by Martínez-Serrano et al. 1, which demonstrated that early detection of complicated abdominal hernias may be the best means of reducing the rate of mortality.

From the Research

Clinical Assessment Findings for Obstructed Femoral Hernia

• The clinical assessment findings for obstructed femoral hernia typically include abdominal pain, as reported in studies 2, 3.
• Diagnosis is often confirmed using computed tomography, which can identify small bowel incarceration 2.
• The presence of bowel obstruction can lead to increased time between symptom development and hospitalization, as well as longer hospital stays 3.
• Clinical examination can also reveal the presence of an incarcerated femoral hernia, which may require urgent surgical intervention 4.

Surgical Intervention and Outcomes

• Laparoscopic techniques, such as the partial iliopubic tract resection technique, have been shown to be safe and effective for the treatment of incarcerated femoral hernias with bowel involvement 2.
• Totally extraperitoneal laparoscopic (TEP) access has also been used to treat femoral hernias, with low conversion and complication rates 5.
• Open surgical repair is also a common approach, particularly in emergency situations, and may be necessary in cases where laparoscopic techniques are not feasible 6.
• The choice of surgical technique may depend on various factors, including the presence of bowel obstruction, the patient's overall health, and the surgeon's expertise 3, 6.

Patient Characteristics and Outcomes

• Femoral hernias are more common in females, with a female-to-male ratio of approximately 8:1 5.
• The mean age of patients with femoral hernias is typically around 60 years, although the age range can vary widely 5, 6.
• Patients with bowel obstruction due to femoral hernia may experience higher morbidity and mortality rates, highlighting the importance of prompt diagnosis and treatment 3.