A 70-year-old woman presents with a tender, irreducible lump in the right groin below and lateral to the pubic tubercle. The overlying skin is erythematous. What type of hernia is this most likely to be and what is the highest priority management?
- A Indirect inguinal hernia; trial of manual reduction (taxis) under sedation
- B Direct inguinal hernia; elective repair within 4 weeks
- C Femoral hernia; urgent surgical exploration and repair as femoral hernias have the highest strangulation risk ✓
- D Spigelian hernia; CT confirmation before repair
Correct answer: C. Femoral hernia; urgent surgical exploration and repair as femoral hernias have the highest strangulation risk
Explanation
A tender irreducible groin lump below and lateral to the pubic tubercle with skin changes in an elderly woman is a strangulated femoral hernia until proven otherwise. Femoral hernias have the highest rate of strangulation among all hernias (15–20% present with strangulation vs. ~3% for inguinal). Urgent surgical exploration is mandatory; taxis is contraindicated in suspected strangulation as it may reduce ischemic bowel back into the abdomen. Femoral hernias are more common in women due to wider femoral canal.
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.