Presentation
Elderly male patient with large red tender lump of short duration around the right mons pubis. Abscess?
Patient Data
Non-contrast CT scan due to renal impairment.
Gaseous structure in the right femoral region with multiple small surrounding satellite foci of gas.
This is continuity through a small 'funnel shaped' neck with a loop of non distended distal small bowel. This lies medial to the femoral vessels.
Couple of tiny foci of free gas in the right iliac fossa.
Gallstones.
Enlarged prostate.
Left basal lung inflammatory changes.
Case Discussion
Femoral hernia occurs almost exclusively in the female.
In this case, there was genuine clinical confusion. A portable ultrasound didn't indicate an abscess and indicated gas, but no peristalsis to indicate a loop of bowel in the groin.
The narrow neck indicates incarceration of the hernia which contains small bowel, with the gas in the hernia suggestive of ischemia and perforation.
An incarcerated right femoral hernia with ischemic perforated small bowel as identified and treated at surgery.
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