A 72-year-old woman presents with a painful irreducible swelling in the right groin below and lateral to the pubic tubercle. The overlying skin is erythematous. Which hernia is most likely and what is the greatest surgical concern?

• A Femoral hernia with strangulation — highest risk of strangulation among groin hernias ✓
• B Indirect inguinal hernia with incarceration
• C Direct inguinal hernia with incarceration
• D Obturator hernia with strangulation

Explanation

A swelling below and lateral to the pubic tubercle in an elderly woman is characteristic of a femoral hernia. Femoral hernias have the highest risk of strangulation among all groin hernias due to the rigid and narrow femoral ring (bounded by the lacunar ligament medially, inguinal ligament anteriorly, Cooper's ligament posteriorly, and femoral vein laterally), which prevents spontaneous reduction. The female preponderance is due to the wider pelvis and larger femoral canal. Femoral hernias should always be repaired urgently once diagnosed due to the high strangulation risk.

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.