Surgery
A 70-year-old women p7+1 with chronic constipation presented to Emergency Room with abdominal distension and…
A 70-year-old women p7+1 with chronic constipation presented to Emergency Room with abdominal distension and vomiting. Examination revealed abdomen is distended, tympanic, with round tender non-reducible swelling in the right groin bellow and lateral to pubic tubercle. X-ray abdomen: Distended small bowel with multiple fluid levels. Which of the following is the most likely diagnosis?
Explanation
Core Concept: Femoral hernia presenting with acute mechanical small bowel obstruction and strangulation.
Clinical Presentation:
- Elderly, multiparous woman with signs of bowel obstruction (vomiting, distension, tympany) and a tender, non-reducible groin mass located *below and lateral* to the pubic tubercle. This anatomical landmark distinguishes it from inguinal hernias, which emerge above and medial to the pubic tubercle.
- Complications: High risk of incarceration and strangulation due to the narrow, rigid femoral ring.
Diagnosis:
- First-line: Clinical examination and plain abdominal X-ray (showing small bowel obstruction).
- Gold standard: CT scan of the abdomen and pelvis to confirm the hernia contents and assess for bowel ischemia.
Management:
- Acute/Definitive: Emergent surgical exploration and hernia repair due to the high likelihood of strangulated bowel.