Femoral hernia. Review of 2,105 repairs in a 17 year period

A series of 2,105 femoral hernia repairs performed in a 17 year period has been reviewed. Of these, 1,138 were primary and 967 were recurrent. In the majority of the primary repairs (730 in men and 408 in women), a low or subinguinal approach was used. There was often an ipsilateral inguinal hernia, particularly in men, that required a separate simultaneous routine repair. An overall recurrence rate of approximately 2 percent was achieved in the primary group. Of the recurrent repairs, 778 were in men and 189 in women. The subinguinal approach was favored in the majority of these patients also. The rerecurrence rate was approximately 10 percent in men and 7 percent in women. Despite this, the low approach has still often been considered the best. These recurrent repairs are frequently difficult to treat. A strategy for the treatment of the larger and the more difficult recurrent femoral hernias has been suggested herein.

A young man with a femoral hernia presenting as periumbilical pain

The case of a 21-year-old man presenting with constant periumbilical pain is reported. The patient had a left groin mass which on palpation exacerbated his pain. The patient was taken to surgery where an incarcerated femoral hernia was repaired. A brief and uncomplicated postoperative course followed. The anatomy and clinical manifestations of femoral hernias are presented.

Strangulated stomach within a femoral hernia

A complication of femoral hernia not previously described, namely gastric strangulation, is reported.

Inguinal and femoral hernia repair in geriatric patients

In a five year period, 62 patients aged 70 to 91 years underwent operative inguinal hernial repair. Other significant ailments were present in 46 of the 51 men and six of the 11 women. Postoperatively, complications occurred in 16 patients, four of whom died. In 44 patients with reducible hernia undergoing elective repair, there were no deaths and complications occurred in eight, while, in contrast, of the 18 with incarcerated or strangulated hernia, complications occurred in ten, and four died. The differences statistically significant. Local anesthesia was associated with the lowest complication rate. All cardiovascular complications and all deaths occurred in those receiving either general or spinal anesthesia. Inguinal herniorrhaphy can be safely performed in geriatric patients. Because of high morbidity and mortality associated with incarceration, elective repair of inguinal hernia under local anesthesia should be done whenever possible.

Appendicitis in external herniae

Seven patients are reported with acute appendicitis occurring in an external hernial sac. The average age was 69 years. In 4 cases the site was a right femoral hernia and in 3 a right indirect inguinal hernia. In no case was the correct diagnosis made before operation. Recovery was uneventful apart from wound infection in 3 cases.

[Strangulation of Meckel's diverticulum in a crural hernia (Littre's hernia). Presentation of a rare case in a male patient]

A rare case of narrowed Meckel's diverticulum in a right crural hernia sac is reported in a male patient.

Bilateral obturator herniae and associated femoral hernia

A case of a strangulated obturator hernia associated with a strangulated femoral hernia is reported. The development of obturator herniae and their association with other herniae are discussed.

Appendix abscess in a femoral hernial sac - case report and review of the literature

The case of an appendix abscess situated in a rightsided femoral hernial sac is reported. The aetiology, diagnosis and treatment of this rare condition are discussed.

Femoral hernia with upward extension into abdominal wall: CT diagnosis

The usefulness of computed tomography (CT) in identifying the nature of abdominal masses is well documented. A rare form of femoral hernia was observed extending upward within the abdominal wall. CT was helpful in determining that this was a hernia and not an intraabdominal mass.

[Internal abdominal hernias. Presentation of 10 treated cases]

Ten cases of abdominal internal hernia observed at the Niguarda Hospital Emergency Surgery Division, Milan, during the period 1969-1978 are described. Even though it is extremely uncommon, this form must be kept in mind in the course of differential diagnosis when the picture includes: typical and striking symptoms of ileal strangulation, radiographical evidence of marked distension of the ileal loops with hydro-air levels, and a negative history of abdominal surgery.

Surgical intervention in complications of acute leukemia

Aggressive chemotherapy has dramatically increased the number and duration of remissions in acute leukemia. Concomitant with improved survival has been an increased incidence of complications necessitating surgery in patients with chemotherapy-induced pancytopenia. In the past, patients such as the three described here rarely survived, whether managed conservatively or surgically. All three of these achieved partial or complete remisson. In view of our experience plus reports in the literature, we feel that aggressive surgical intervantion can result in a greater percentage of patients surviving the complications of therapy, and this in turn can lead to a higher incidence of complete remission.

Cancer in inguinal and femoral hernias

Three cases of malignant tumors associated with hernial sacs are presented. One case of a primary liposarcoma of the spermatic cord illustrates the necessity of examining all excised specimens microscopically. The two cases of metastic disease from colonic and rectal primaries support the observation that the most frequent primary site for neoplastic disease within hernial sacs in the large bowel. Neoplasm within a hernial sac should be suspected in patients with previously diagnosed intraperitoneal malignancy who present with a new hernia, and in elderly patients who develop incarceration of a chronic, previously reducible hernia. Local phenomena such as intraperitoneal seeding by gravity are probably most important in explaining the unusual finding of metastatic tumor foci within hernial sacs. Suggestions for increasing diagnostic yield include biopsy and frozen-section examination of suspect specimens and, in cases in which tumor is confirmed, thorough intraperitoneal digital palpation and laparoscopy. The hernial sac offers a unique opportunity for peritoneal biopsy that should not be overlooked.

Femoral hernia with strangulated Meckel's diverticulum (Littre's hernia)

An unusual complication of a Meckel's diverticulum, a strangulated Littre's femoral hernia, is presented. The incidence and complications of Meckel's diverticulum are discussed. It is emphasized that most complications occur before age 30. Thus in an adult an incidentally discovered Meckel's diverticulum should not be resected.

Obstructed groin hernia in a tropical African population

In a 15-month period, at the University College Hospital, Ibadan, 44 cases of obstructed hernia were treated by emergency operation. More than 94 percent were inguinal, but femoral hernia was not common. The ratio of females to males was 1:6.4, and more than 68 percent of hernias occurred on the right side. The youngest patient was two weeks old. One incarcerated hernial sac contained an ileoileal intussusception and a segment of sigmoid colon.

Chicken bone herina: an unusual presentation of a Richter's hernia

An unusual case of a perforated Richter's hernia in which is presented with abscess cavity contained a chicken bone. Richter's gernia is difficult to diagnose before strangulation occurs. The surgeon must be prepared to follow small bowel resection with a second operation for definitive repair of the hernia.

Ruptured appendicitis in femoral hernias: report of two cases and review of the literature

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