A 55-year-old woman presents with a small painful lump below and lateral to the pubic tubercle. She has no history of prior hernia or surgery. The most likely diagnosis and its embryological basis is:

• A Direct inguinal hernia — weakness in transversalis fascia medial to inferior epigastric vessels
• B Obturator hernia — protrusion through obturator foramen with medial thigh pain
• C Spigelian hernia — protrusion through semilunar line lateral to rectus abdominis
• D Femoral hernia — protrusion through femoral ring medial to femoral vein ✓

Explanation

A painful lump below and lateral to the pubic tubercle (medial to the femoral vein, below the inguinal ligament) in a middle-aged woman is characteristic of a femoral hernia. Femoral hernias protrude through the femoral canal, bounded by the inguinal ligament anteriorly, pectineal ligament posteriorly, lacunar ligament medially, and femoral vein laterally. They are more common in women due to wider pelvis creating a larger femoral ring. Femoral hernias have a high risk of strangulation (up to 40% present with strangulation) and require prompt repair. Inguinal hernias emerge above and medial to the pubic tubercle. Obturator hernia causes inner thigh pain (Howship-Romberg sign) not a palpable lump.

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.