Femoral hernia on herniography

Case contributed by J. Ray Ballinger
Diagnosis certain

Presentation

Developed left groin pain after lifting a heavy object.

Patient Data

Age: 25 years
Gender: Male
Fluoroscopy

Using sterile technique and local anesthesia, a 22G Chiba needle was inserted into the peritoneal cavity and 50 mL of non-ionic contrast was injected. The patient was asked to walk for 10 minutes before taking films.

Plain film of the pelvis shows contrast outlining loops of bowel. A left-sided hernia is seen filled with contrast containing a narrow neck that parallels the superior pubic ramus. 

Case Discussion

Surgery confirmed presence of this femoral hernia. 

Femoral hernias are less than 10% as frequent as inguinal hernias. They are more common in females and on the right side. They may be difficult to distinguish from indirect inguinal hernias. 

Femoral hernias have a narrow neck while passing through the femoral canal and are prone to incarceration. On herniography the direct hernia is described as pear-shaped with a narrow neck. The upper posterior border of the neck parallels the superior pubic ramus.

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