A 72-year-old woman presents to the emergency department with a 6-hour history of a painful, irreducible femoral hernia. CT confirms bowel obstruction with a loop of small bowel in the hernia sac. During emergency surgery, the hernial sac is opened and the bowel is found to be viable. Which anatomical structure must be divided to allow reduction of the femoral hernia and should NOT be mistaken for a structure that would compromise the patient?

• A Inguinal ligament (Poupart's ligament)
• B Lacunar ligament (Gimbernat's ligament) ✓
• C Iliopubic tract
• D Cooper's (pectineal) ligament

Explanation

The femoral canal is bounded medially by the lacunar ligament (Gimbernat's ligament), laterally by the femoral vein, anteriorly by the inguinal ligament, and posteriorly by Cooper's (pectineal) ligament. In a strangulated femoral hernia, division of the sharp medial edge of the lacunar ligament is required to enlarge the femoral ring and reduce the hernia. The surgeon must be aware that an aberrant obturator artery ('corona mortis' vessel, present in ~20% of patients) may run along the medial aspect of the lacunar ligament — inadvertent division can cause life-threatening hemorrhage. Cooper's ligament serves as the posterior repair site (McVay repair).

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.