FEMORAL HERNIA: UNCOMMON, BUT ASSOCIATED WITH POTENTIALLY SEVERE COMPLICATIONS

From inguinal to giant femoral hernia: An unusual postoperative twist - A rare case report

INTRODUCTION AND IMPORTANCE

Femoral hernias following inguinal hernia repairs are an unusual occurrence that presents diagnostic challenges for healthcare providers. Surgical repair of inguinal hernias is generally successful, but complications and recurrence can arise. The coexistence of femoral hernias following inguinal hernia repairs is rare, requiring careful evaluation and management.

CASE PRESENTATION

A middle-aged patient sought medical attention with complaints of recurrent groin pain and a palpable bulge in the inguinal region. Initial imaging studies, including ultrasonography and contrast-enhanced computed tomography (CT), pointed towards an inguinal hernia, leading to the scheduling of surgical repair. However, during the operation, the surgeon discovered a femoral hernia, highlighting the limitations of imaging techniques in accurately diagnosing these hernia types.

CLINICAL DISCUSSION

Due to anatomical variations and overlapping signs and symptoms, distinguishing between femoral and inguinal hernias can be challenging. Scar tissue from previous inguinal hernia repairs can further complicate imaging interpretations. Intraoperative exploration becomes crucial to confirm the diagnosis and facilitate proper surgical repair.

CONCLUSION

The reported case emphasizes the importance of maintaining vigilance in evaluating patients with suspected hernias, particularly those with prior inguinal hernia repairs. Relying solely on imaging studies can lead to misdiagnosis, as illustrated by the discovery of a femoral hernia during surgery. Healthcare providers should be aware of the possibility of femoral hernias and conduct comprehensive evaluations to ensure timely intervention and improve patient outcomes. Further research and awareness are essential to optimize the care of such uncommon clinical scenarios.

Treatment of recurrent hernia in peritoneal dialysis patients

Peritoneal dialysis (PD) is the most commonly used treatment for patients with end-stage renal disease and has the advantages of simple operation and low treatment costs. However, long-term PD may lead to inguinal hernia formation, which needs to be repaired as early as possible. There are many studies on this kind of hernia, but there are few reports about how to treat recurrent hernia in PD patients. Therefore, we present a case of a female PD patient who suffered from a recurrent femoral hernia after primary hernioplasty. We successfully proceeded with treatment by laparoscopic transabdominal preperitoneal hernia repair. The patient was scheduled to receive temporary haemodialysis until the normal PD dose was restored. After 36 months of follow-up, we found that there was no recurrence of hernia, and the function of the PD catheter was normal.

The Utility of Minimally Invasive Surgery in the Emergency Management of Femoral Hernias: A Systematic Review

Background: Femoral hernias are a relatively rare type of hernia but have a high complication rate, with a high proportion either presenting as an emergency or requiring emergency management. Minimal access surgery has been shown to be safe, with good results, in an elective setting, but there is little published evidence of its utility in an emergency. Methods: A systematic review was conducted searching PubMed, OVID, Embase, and Cochrane reviews for ((Femoral hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). Results: 286 manuscripts were identified of which 33 were relevant. 24 were individual case reports, 3 case series, 4 cohort studies or case control series, and 2 high level reviews of National registers. Conclusion: Minimal access surgery can avoid an unnecessary laparotomy for the assessment of hernial contents, especially via a TAPP approach. Minimal access repair of femoral hernias as an emergency is feasible and can be done safely with results similar to open surgery but good quality evidence is lacking.

Application of spatial replacement method in the treatment of laparoscopic incarcerated femoral hernia – A case report

Introduction

Incarcerated femoral hernia is a common surgical acute abdominal disease. Laparoscopic surgery is considered a safe and effective method for treating incarcerated femoral hernias, which have different surgical approaches to releasing the contents of the hernia.

Presentation of case

We report the case of a 65-year-old female with a right incarcerated femoral hernia with an irreducible mass in the right femoral region for 2 days diagnosed by physical examination and abdominal ultrasonography. We used a catheter to inject normal saline into the hernia sac during surgery. Injury and rupture of the small intestine were avoided, and the polypropylene mesh was successfully repaired.

Discussion

Incarcerated femoral hernias is a common surgical emergency that can lead to intestinal obstruction, strangulation, or infarction. Laparoscopy is advantageous for treating incarcerated femoral hernias. In our case, spatial replacement theory was used to release the incarcerated small intestine. The principle is that changing the internal and external pressures of the hernial sac returns the hernia contents. The non-necrotic small intestine did not lead to intraperitoneal infection, and the standard transabdominal preperitoneal repair was simultaneously performed with a polypropylene mesh.

Conclusion

Laparoscopic incarcerated femoral hernia repair is a common emergency surgery that is safe and feasible for treating incarcerated femoral hernia using the spatial replacement method, the most beneficial to patients.

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Laparoscopic exploration to determine bowel activity in incarcerated femoral hernias

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Using the space replacement method to successfully release the incarcerated small intestine can avoid iatrogenic intestinal damage

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The non-necrotic small intestine will not cause intra-abdominal infection, and at the same time use polypropylene mesh for standard TAPP repair to avoid secondary hernia repair