Non-obstructed femoral hernia containing ascending colon, caecum, appendix and small bowel with concurrent bilateral recurrent inguinal hernia

Abstract

Femoral hernias, which are less common than inguinal hernias and more often found in females, occasionally contain more than just small intestine and omentum. Uncommon contents reported in femoral hernia sacs include caecum, appendix, Meckel's diverticulum (Littre hernia), testis, ovary, transverse colon and even stomach or kidney. Strangulation of femoral hernias containing appendix, small intestine and caecum, and Meckel's diverticulum are well reported in the literature. Here, we report a case of a male patient having bilateral femoral hernia with bilateral recurrent inguinal hernia. A huge, right-sided femoral hernia contained terminal ileum, appendix, caecum and ascending colon, which were irreducible but neither obstructed nor strangulated. The patient was operated on with a Pfannenstiel incision together with an infrainguinal incision. For reduction of content, an inguinal ligament was also incised. Bilateral preperitoneal, polypropylene mesh hernioplasty was performed along with rolled plug placement in the right femoral canal. The patient had an uneventful post operative recovery and no recurrence in 6 months of follow up.

Richter's type strangulated femoral hernia containing caecum and appendix masquerading as a groin abscess

“…The hernia sac commonly consists of small bowel or omentum, but uncommon cases have been reported, where the herniating structures were caecum, appendix, colon, Meckel’s diverticulum, ovaries, testes, stomach and kidneys (2,4). …”

Tratamento laparoscópico de hérnias femoral e obturadora concomitantes

“…As hérnias femoral e obturadora são raras e conhecidas por ser de díficil diagnóstico. A hérnia femoral é mais comum em pacientes do sexo feminino e de idade avançada 9,10 . A tomografia é, frequentemente, a única forma de diagnosticar de forma acurada a hérnia obturadora 11 .Anatomicamente, os canais femoral e obturador estão próximos, o que pode dificultar a identificação das hérnias e parecer uma hérnia inguinal.…”

Strangulated Femoral Hernia: A Challenging Surgical Vignette —Case Report and Review of Literature

“…An added laparotomy approach may also be useful in those femoral hernias which contain a variety of rare abdominal contents such a caecum, ascending colon, Meckel's diverticulum, ovary, fallopian tube and a bladder diverticulum [8][9][10][11][12]. Difficult situations may arise when any part of the colon gets trapped in the incarceration [11]. Clear identification of the proximal and distal end is pivotal in safe reduction and optimum decision making in strangulated femoral hernias.…”