Ultrasound diagnosis of occult femoral hernia presenting with intestinal obstruction

Role of Sonography in Clinically Occult Femoral Hernias

OBJECTIVES

The purpose of this article is to evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique.

METHODS

The clinical and imaging data for 93 outpatients referred by general surgeons, all of whom underwent sonographic evaluation and surgery, were reviewed retrospectively. Of these, 55 patients who underwent surgical exploration for groin hernias within 3 months of sonography and met all inclusion criteria were included in the study. The sonographic technique involves using the pubic tubercle as an osseous landmark to identify and appropriately visualize the femoral canal. The Valsalva maneuver is then used to differentiate the movement of normal fat (a potential pitfall) from true herniation in the femoral canal. Surgical findings were used as the reference standard by which sonographic results were judged. Two-by-two contingency tables were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value.

RESULTS

In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True-positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein.

CONCLUSIONS

Sonography can exclude femoral hernias with high confidence in light of its exceptional negative predictive value. With attention to technique and imaging criteria, the diagnostic accuracy of sonography can be enhanced.

A rare case of femoral herniation of female internal genitalia

We report a rare case with herniation of the uterus, fallopian tube, and ovary in a femoral hernia. A female patient was admitted with complain of the painful lump in the left groin. Clinical examination indicated strangulated femoral hernia, which necessitated an emergency surgery. During surgical procedure, the uterine tube, left fallopian tube and left ovary, were observed as the contents of the hernia. The contents were reduced back into the pelvic cavity, and the hernia was repaired. The patient made good recovery postsurgery.

Accidental small bowel perforation after antegrade femoral artery access for percutaneous thromboembolectomy and angioplasty

PURPOSE

To report a rare complication of antegrade femoral access for percutaneous aspiration thromboembolectomy and transluminal angioplasty.

CASE REPORT

A 73-year-old obese woman underwent antegrade femoral aspiration thromboembolectomy for lower limb arterial embolism. Fifteen hours later, she presented with acute abdomen and decreased hemoglobin. Computed tomography showed small bowel obstruction, incarcerated femoral hernia, and free peritoneal air and fluid suggesting bowel perforation. Emergent laparotomy revealed an incarcerated, perforated femoral bowel loop and 4-quadrant peritonitis.

CONCLUSIONS

Femoral hernia injury is an exceptional complication of vascular interventions. Knowledge of this potential hazard may help to avoid its occurrence.