A 70-year-old woman presents with an irreducible, tender swelling in the right groin below and lateral to the pubic tubercle. The swelling is below and medial to the femoral pulse. The MOST likely diagnosis is:

• A Indirect inguinal hernia passing through the deep ring
• B Direct inguinal hernia medial to the inferior epigastric vessels
• C Saphena varix presenting as a groin swelling
• D Femoral hernia passing through the femoral canal ✓

Explanation

Femoral hernias emerge through the femoral canal, appearing below and lateral to the pubic tubercle and medial to the femoral vessels. They are more common in women (due to wider pelvis/femoral ring), have the highest risk of strangulation of all groin hernias, and present in the femoral triangle below the inguinal ligament. Inguinal hernias (direct or indirect) appear above and medial to the pubic tubercle. Saphena varix is a soft compressible swelling at the saphenofemoral junction that has a cough impulse and emptied by compression (Trendelenburg test).

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.