From the Guidelines
Femoral hernia obstruction is a medical emergency that requires prompt surgical intervention to prevent complications such as bowel necrosis and perforation, which can significantly increase morbidity and mortality rates. The clinical findings for femoral hernia obstruction include pain and tenderness in the groin area, specifically below the inguinal ligament and medial to the femoral vessels, as well as a firm, non-reducible lump that may be palpable in this location 1. Patients may also experience nausea, vomiting, and abdominal distension as intestinal obstruction progresses, along with constipation or obstipation and abdominal cramping.
Some key characteristics of femoral hernia obstruction include:
- A higher risk of incarceration and strangulation compared to inguinal hernias due to the narrow, rigid femoral canal
- A location lateral to the pubic tubercle, unlike inguinal hernias which are superior to it
- Potential for strangulation, which can lead to fever, tachycardia, and signs of systemic inflammation, as well as erythema or discoloration of the skin over the hernia 1.
It is essential to note that delayed diagnosis or treatment of femoral hernia obstruction can result in severe consequences, including the need for bowel resection, prolonged recovery, and increased complication rates 1. Therefore, early recognition and surgical intervention are critical to preventing these outcomes and improving patient quality of life.
From the Research
Clinical Findings for Femoral Hernia Obstruction
- Femoral hernia obstruction can present with symptoms such as intermittent small bowel obstruction, abdominal pain, and ileus 2
- Clinical findings may include a palpable mass in the groin, tenderness, and guarding 3
- However, some patients may not exhibit any noticeable hernial masses on clinical examination, making diagnosis challenging 4
Diagnostic Challenges
- Femoral hernias can be difficult to diagnose due to their location and the fact that they may not always present with a palpable mass 4
- Imaging studies such as CT scans can be helpful in diagnosing femoral hernias, but may not always correlate with operative findings 4
- Point-of-care ultrasound (POCUS) can be a useful tool in diagnosing and risk-stratifying patients with femoral hernias, allowing for the identification of specific ultrasound findings predictive of complications such as incarceration, strangulation, and small bowel obstruction 5
Complications
- Femoral hernia obstruction can lead to serious complications such as bowel ischemia, necrosis, and perforation 2
- The presence of bowel obstruction is associated with a longer hospital stay, increased morbidity, and mortality 2
- Early surgical intervention is crucial in preventing these complications and improving outcomes 3, 4, 2
Treatment
- The treatment of femoral hernia obstruction typically involves surgical repair, which can be performed using an open or laparoscopic approach 3, 6
- The choice of surgical approach depends on the individual patient's circumstances, including the presence of complications and the surgeon's preference 3, 6
- The use of mesh plug techniques, such as the PerFix mesh plug, has been shown to be effective in reducing recurrence rates and postoperative complications 3