A 68-year-old thin woman presents with a small, tense, irreducible, tender swelling below and lateral to the pubic tubercle. There is no vomiting and she continues to pass flatus, but the swelling has become increasingly painful with overlying erythema over several hours. Which statement best describes this condition?

• A Complete obstruction of the lumen always precedes strangulation in this hernia type
• B It involves only part of the circumference of the bowel wall and can strangulate without causing intestinal obstruction ✓
• C It most commonly contains omentum, explaining the absence of obstructive symptoms
• D It is a variety of indirect inguinal hernia passing through the cremasteric fascia

Explanation

This is a Richter hernia, in which only the anti-mesenteric border of the bowel forms a knuckle through a narrow neck, classically the femoral ring in elderly women. Because the lumen is not circumferentially compromised, obstruction does not occur, so there is no vomiting or constipation, yet the narrow neck compresses the blood supply and strangulation develops rapidly. This deceptive absence of obstructive features delays diagnosis, making a painful irreducible hernia an indication for urgent exploration.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.