Intestinal Obstruction due to Bilateral Strangulated Femoral Hernias

Abstract

Introduction. Femoral hernias are at high risk of strangulation due to the narrow femoral canal and femoral ring. This can lead to symptoms of obstruction or strangulation requiring emergency surgery and possible bowel resection. To our knowledge, there is only one previous published report of bilateral strangulated femoral hernia. We present our case of this phenomenon. Case Report. An 86-year-old woman presented with symptoms of small bowel obstruction. Examination revealed two tender lumps in the area of the femoral triangle. CT scan revealed bilateral femoral hernias. Both hernias were repaired and a small bowel resection on the right side was performed with side to side anastomosis. She made an uneventful recovery. Conclusion. Bilateral femoral hernias are a rare occurrence with only one reported case of bilateral strangulation. Our case highlights the importance of meticulous history taking and clinical examination as any delay in diagnosis will increase the risk of mortality and morbidity for the patient. Hernias should always be considered as a cause if one presents with symptoms of abdominal pain or obstruction.

Intestinal necrosis and sigmoid colon obstruction due to bilateral strangulated femoral hernia in a male: a rare surgical and anatomic case report

“…The presence of the bilateral femoral hernia is extremely rare since only a few cases are documented in the literature [ 1 , 2 , 4 ], with minor reports of male patients [ 3 , 4 ]. Furthermore, bilateral strangulation is documented only for a female patient [ 3 , 5 ].…”

“…When remaining asymptomatic, their differential diagnosis may be challenging since mimicking venus aneurysms of the sapheno-femoral anastomosis, especially for obese patients [ 1 , 3 ]. Ultrasonography, CT and MRI are extremely helpful for the adequate differential diagnosis [ 4 ].…”

“…There are several documented surgical approaches for the repair of a femoral hernia depending on the type of the hernia and the surgeon’s experience [ 1 , 4 ]. Nevertheless, if feasible, laparoscopy is more favorable due to alleviating the probability of recurrence and the post-operative pain [ 4 ].…”

“…Femoral hernias are prone to strangulation because of the rigid femoral ring and the narrow femoral canal [ 3 ]. However, there are only two cases of bilateral strangulated femoral hernias, and these occur solely in females [ 4 , 5 ]. To our knowledge, in the present manuscript, a bilateral strangulated femoral hernia in a male patient is reported for the first time in the literature.…”

Small Bowel Obstruction Secondary to Femoral Hernia: Case Report and Review of the Literature

“…Rogers 5 reported a review on 170 cases of strangulated femoral hernia and its complications. Two study report strangulated bilateral femoral hernia [6,7] This hernia could include: stomach, omentum, colon, small intestines (the partially strangulated small intestine wall called Richter's hernia), the appendix (De Garengeot hernia) 9 , urinary bladder, fallopian tube and ectopic testis 8 . The differential diagnosis of femoral hernia includes inguinal lymph nodes, direct and indirect inguinal hernia, and hydrocele of the cord or canal of Nuck, the greatest saphenous vein varices, femoral artery aneurysm, ectopic testis and psoas abscess 10 .…”