(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Femoral hernia, a category of inguinal hernia, is a type of hernia in which the hernia sac protrudes into the oval fossa via the femoral ring and femoral canal, mostly in middle-aged and elderly women, and presents as a half spherical protrusion below the inguinal ligament. As in the present case, because of the unintentional discovery of a right inguinal reversible mass, the patient’s prognosis is good through timely surgical treatment and no recurrence has been seen so far.
Basic information】Female, 48 years old
Disease Type】Femoral hernia
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】November 2021
Treatment plan】Surgical treatment (tension-free repair of right femoral hernia) + medication (moxifloxacin hydrochloride tablets, potassium chloride for injection, glucose injection)
Treatment period】9 days of hospitalization and six months of follow-up
Effectiveness】The right inguinal mass disappeared, and no recurrence has been seen so far.
I. Initial consultation
Six days ago, the patient unintentionally found a lump protruding from the lower part of the right groin, which disappeared after pressing, but after that, she found that the lump often reappeared after prolonged standing or coughing. Today, he came to our hospital. Examination: a mass of about 3×4 cm in size could be palpated under the right inguinal ligament, with protruding mass and slight pressure pain, smooth surface and soft texture, disappeared after lying down. Ultrasound: intestinal tube-like echogenicity in the right lower inguinal region. Combining the patient’s history, physical signs and auxiliary examinations, the initial diagnosis was right femoral hernia, and the patient was admitted to the hospital for further treatment after completion of nucleic acid testing.
II. Treatment history
Immediately after admission, the patient underwent routine blood tests, liver and kidney functions, ECG, X-ray, CT and other relevant examinations to exclude other related diseases. The CT showed that the right femoral hernia was clearly diagnosed. I informed the patient and her family that this disease required timely surgery to return the intestinal canal, otherwise it would easily lead to ischemic necrosis of the intestinal canal. The patient was then treated with a high ligation to remove the hernia sac, sutured to close the femoral ring and placed a patch to reinforce it. After the operation, the patient was advised to fast, change medication regularly, give moxifloxacin hydrochloride tablets to prevent infection, injectable potassium chloride, glucose injection and other rehydration and nutritional support treatment, and gradually transition to general diet after recovery of gastrointestinal function.
(CT back shows: right femoral hernia with fat and fluid below the origin of the inferior abdominal wall artery and medial to the femoral vessels, and the hernia sac is located lateral to the nodes)
III. Treatment results
The patient received surgical treatment for right femoral hernia in our hospital. After the operation, the patient’s vital signs were stable, no complications such as infection, good healing of the incision, occasional pain but tolerable, complete disappearance of the right inguinal mass, and no significant abnormalities were found in the repeat blood tests and ultrasound. On the 9th day of hospitalization, the patient recovered well and was discharged satisfactorily. On re-examination 1 week after discharge, the incision was free of redness, swelling and oozing, and basically healed, and stitches were removed. 3 months later, on re-examination, the incision was completely healed, no recurrent inguinal mass was found on ultrasound, and the patch was seen to be intact and in good position. the patient has resumed normal life, and no recurrence has been seen so far.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but the patient still needs to pay attention to some care matters.
1. after discharge from the hospital, attention should be paid to regular re-examinations to understand the recovery, and usually attention should be paid to monitoring the condition. when a mass reappears in the groin or acute pain occurs in the abdomen, prompt medical attention should be sought to avoid serious complications such as intestinal necrosis due to hernia entrapment.
In addition to the necessary treatment, daily care is also important. For 3 months, physical activity and strenuous exercise are prohibited to avoid wound tearing or patch displacement, appropriate activities such as walking and jogging can be carried out, and behaviors that cause increased intra-abdominal pressure such as coughing and heavy lifting should be avoided as much as possible.
3, diet, try to eat less and more meals, to light, easy to digest diet, eat more legumes and fruits and vegetables, drink more water to avoid constipation.
V. Personal insight
Femoral hernia is a special category of inguinal hernia. Unlike inguinal hernia and hiatal hernia, femoral hernia can easily lead to intussusception, which is characterized by enlargement of the hernia mass, pain and inability to retract, and can be accompanied by intestinal obstruction such as nausea, vomiting, abdominal distension and cessation of defecation, etc. If left untreated, it can develop into strangulated hernia, which can lead to necrosis and perforation of intestinal collaterals, sepsis, etc. The condition is very dangerous. In addition, I am very glad that the patient has some knowledge about femoral hernia, and I am happy that she was treated in time and finally completely cured without serious complications. The risk is greater. Common complications of femoral hernia include easy complication of incarcerated hernia or strangulated hernia, which may be life-threatening if left untreated.