A 70-year-old woman presents to the emergency department with a tender, irreducible groin swelling just below and lateral to the pubic tubercle. The most likely diagnosis and the structure most at risk of ischemia in this hernia type is:

• A Indirect inguinal hernia; small bowel most at risk
• B Femoral hernia; knuckle of bowel most at risk due to narrow neck ✓
• C Direct inguinal hernia; bladder most at risk
• D Obturator hernia; obturator nerve most at risk

Explanation

Femoral hernias present below and lateral to the pubic tubercle, pass through the femoral canal (the most medial compartment of the femoral sheath), and have an unyielding neck bounded by the inguinal ligament anteriorly, lacunar ligament medially, Cooper's ligament posteriorly, and femoral vein laterally. This rigid ring makes femoral hernias highly prone to strangulation (30-40% of femoral hernias presenting acutely are strangulated). They are more common in older women (wider pelvis) and carry higher morbidity than inguinal hernias.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.