Ventral hernia is commonly referred to as “hernia” and “small bowel gas”. What we are going to describe here today is a slightly unusual “swelling” at the root of the thigh that is clinically very dangerous and should be operated on as soon as it is diagnosed, and which resembles a lipoma on physical examination or even shows up as a lipoma on ultrasound reports. As we know, lipomas are the most common benign subcutaneous masses in the outpatient setting and are mostly solitary, soft, painless subcutaneous masses with clear borders. The clinical management is resection or follow-up, including regular physical examination and ultrasound review. But you will not imagine how a lipoma at the root of the thigh in an ultrasound report can progress to become the culprit of intestinal necrosis and intestinal resection surgery. “Femoral hernia”, which is really a hernia, is prone to misdiagnosis due to high rate of impaction, insidious condition, and wrong interpretation of examination results. This hidden killer that endangers the health of middle-aged and elderly women is being unmasked. ”Femoral hernia”, the general surgical name for this disease, is more common in middle-aged and elderly women who have given birth, and less common in men. Clinical femoral hernia is relatively rare, and according to the literature the incidence is only about 3%-5% of extra-abdominal hernias, and about 40% of patients are already embedded at the time of consultation. The pathology is generally believed to be a weak skeletal lumbar muscle in women after multiple childbirths, resulting in a wide relaxation of the femoral ring and protrusion of the abdominal contents (mostly small intestine and large omentum) through the fossa ovalis when the intra-abdominal pressure increases. A non-strangulated hernia presents as a spherical mass located at the root of the thigh, which increases in size when standing or coughing and can be retracted when lying down. However. In most patients, even after the hernia mass is completely retracted, a mass formed by extraperitoneal fat can be palpated, which is easily misdiagnosed as a lipoma because of the accumulation of fat outside the hernia sac. The surface is not red and is usually painless. Clinically, femoral hernias with pain are also easily misdiagnosed as abscesses and lymphadenitis, and multiple antibiotics are applied for a long time. Because of the narrow neck of the femoral canal and the sharp medial border, femoral hernias are prone to entrapment and strangulation. Misdiagnosis of cystic with painful femoral hernia as fluctuating abscess and incision and drainage of pus can result in intestinal fistula, which may not heal after a long time or death. When the intestinal wall is embedded and the intestinal canal is stuck, it mainly manifests as abdominal pain and is easily misdiagnosed as an organ disorder such as gastritis. When the entire intestinal canal is embedded, it is manifested as intestinal obstruction. Once the diagnosis of intestinal blood flow disorder and intestinal necrosis is confirmed, the patient needs to undergo partial intestinal resection and intestinal anastomosis under general anesthesia. Another common misdiagnosis: nodular enlargement of saphenous vein; round ligamentous cyst of uterus: painless mass in female inguinal region, round or oval, tough or cystic, slightly mobile, enlarges when standing or increasing abdominal pressure, shrinks when lying down, only light pressure pain or no pressure pain on physical examination, cystic in nature. High-frequency ultrasound can be the preferred method of examination for inguinal lesions such as uterine round ligament cysts. In patients with acute abdominal pain, femoral hernias are often missed in patients presenting with acute intestinal obstruction, usually due to the fact that femoral hernias are more common in older women,
The reason is that femoral hernia is more common in elderly women, who are reluctant to provide information about the lesions near the vulva and are uncooperative during physical examination, which can easily lead to missed diagnosis. The symptoms of acute intestinal obstruction, such as abdominal pain and vomiting, mask the local symptoms when the femoral hernia is acutely intussusception. Patients with surgical history of intestinal obstruction are one-sidedly considered to have postoperative adhesive intestinal obstruction. Physical examination is not meticulous: femoral hernias are generally small, not easily retractable, and without a history of repeated protrusion. However, most physicians do not fully expose the patient’s perineum during physical examination, and the inguinal region is easily missed. The clinical manifestations of femoral hernia are not well understood. Surgical treatment of femoral hernia can be performed by five methods: Mcvey’s hernia repair, mesh hernia repair, preperitoneal pubic foramen coverage, superior inguinal ligament repair, and inferior inguinal ligament repair. Once any femoral hernia is detected, even if the patient is not in discomfort, surgery should be scheduled as soon as possible. The presence of inguinal masses should not be ignored by chance. Once an emergency hernia with intestinal necrosis is seen, the lack of preoperative evaluation and hernia diagnosis often affects the clinical emergency physician’s judgment and creates unnecessary obstacles to the diagnosis and treatment process.