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Case Report: Small Bowel Obstruction Secondary to Incarcerated Femoral Hernia

Johaniya Dimaporo, Ronalyn Bautista M and Virgilio Banez

A hernia is a protrusion, bulge, or projection through the body wall of an organ or part of an organ. The inguinal and femoral hernias are collectively known as groin hernias. Femoral hernias are located inferior to the inguinal ligament and, which is medial to the femoral vein and lateral to the lacunar ligament. With aging and after injury, the femoral ring can widen and become patulous. It accounts for <10 percent of all groin hernias and only 2 to 4 percent of all groin hernia repairs. 2 They represent 20 to 31 percent of repairs in women compared with only 1 percent in men. Two common complications can be incarceration or strangulation.This usually occur because of the narrow femoral canal and rigid femoral ring. Incarceration is defined as trapping of hernia contents within the hernia sac such that reducing them back into the abdomen or pelvis is not possible. Reduced venous and lymphatic flow leads to swelling of the incarcerated tissue, which can be bowel (small, large, appendix), omentum, bladder or ovary, or other structures. As edema accumulates, venous and arterial flow to the contents of the hernia sac can become compromised, resulting in ischemia and necrosis of the hernia contents, which is referred to as strangulation 6. Most common symptom of femoral hernia is heaviness or dull discomfort in the groin, which may or may not be associated with a visible bulge6. Colicky abdominal pain and vomiting may persevere due to incarceration and obstruction or strangulation of small bowel. On physical examination, there is usually bulge in the groin and may be painful to palpation. The patient may also be febrile, and erythema of groin skin may be apparent. Generally, the diagnosis is clinical but imaging techniques such as ultrasound, CT, MRI or diagnostic laparoscopy may be useful. When diagnosed, femoral hernias should be electively repaired as soon as possible. As a rare cause of gastrointestinal obstruction, 40 percent can still present at emergencies with incarceration or strangulation that could increase mortality and morbidity2. This report describes a case of an incarcerated small bowel in left femoral canal hernia causing small bowel obstruction.