A 70-year-old woman presents with a tender, irreducible swelling below and lateral to the pubic tubercle. She has vomiting and colicky abdominal pain for 12 hours. The diagnosis and emergency management are:

• A Strangulated femoral hernia; repair via low (Lockwood) or high (McEvedy/Lotheissen) approach ✓
• B Strangulated indirect inguinal hernia; repair via inguinal approach
• C Obturator hernia; pelvic CT and emergency laparotomy
• D Spigelian hernia; emergency laparoscopic repair

Explanation

A tender, irreducible swelling below and lateral to the pubic tubercle in an elderly woman is characteristic of a strangulated femoral hernia, which passes through the femoral canal. Emergency repair can be performed via the low (Lockwood) crural approach, the high (McEvedy) extraperitoneal approach, or the Lotheissen inguinal approach; the McEvedy gives best access to inspect and resect bowel if needed.

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.