Incarcerated femoral hernia with small bowel obstruction

Case contributed by Dr Chris O'Donnell

Presentation

Severe abdominal pain ? diverticulitis

Patient Data

Age: 85
Gender: Female
CT

Oral and IV contrast administered as per a routine CT scan for diverticultis

Gross dilatation of fluid-filled small bowel indicative of SBO down to the right groin where there is a hernial sac containing a loop of ileum. Note hernial sac is lateral to the pubic tubercle and compresses the femoral vein. Minimal ascetic free fluid. No portal or mesenteric venous gas. No area of bowel mucosal hypoenhancement seen. 

Upper abdominal solid viscera are unremarkable. 

Case Discussion

Femoral hernias can be difficult to differentiate from inguinal hernias on CT - key is the position of the incarcerated bowel relative to the pubic tubercle (PT) - indirect inguinal hernias start lateral and pass medial to the PT whereas femoral hernias have their neck medially but tend to pass lateral to the PT, extrinsically compressing the femoral vein so:

"when interpreting a CT scan in a patient suspected of having a groin hernia, one may use the following algorithm: When the hernia sac extends medial to the pubic tubercle, the diagnosis of inguinal hernia can be made with confidence. If the hernia sac is located lateral to the pubic tubercle, the presence of venous compression suggests the diagnosis of femoral hernia with a high probability"

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Case information

rID: 17037
Case created: 12th Mar 2012
Last edited: 30th Dec 2016
Inclusion in quiz mode: Included

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