A 72-year-old woman with a known small reducible right femoral hernia declines elective repair. She presents acutely with a 6-hour irreducible painful lump in the right groin below and lateral to the pubic tubercle. She is haemodynamically stable. What is the most important consideration in operative management?

• A Richter's hernia is more common in femoral hernias; bowel viability assessment is critical even if obstructive symptoms are absent ✓
• B The sac should be reduced laparoscopically as first-line
• C A low inguinal (Lotheissen) approach is preferred to enable bowel resection if needed
• D Femoral hernias rarely strangulate; watchful waiting is appropriate

Explanation

Femoral hernias have a high risk of strangulation (approximately 40% within 3 months of becoming irreducible) due to the rigid unyielding femoral ring. Richter's hernia, in which only the anti-mesenteric wall of bowel is entrapped without complete obstruction, is more common in femoral hernias and femoral canals. Because only part of the bowel wall is strangulated, patients may not present with classic intestinal obstruction, yet bowel necrosis can develop silently. Thorough assessment of bowel viability is mandatory even in the absence of obstructive symptoms. The low approach (McEvedy or Lotheissen) is preferred specifically when bowel resection may be required.

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.