LAPAROSCOPIC SOLUTION FOR AN UNEXPECTED FINDING IN AN INCARCERATED FEMORAL HERNIA, FIRST CASE PUBLISHED

Abstract

Abstract Aim Femoral hernias (FH) are relatively uncommon, comprising <2% of all hernias and 2–8% of all inguinal hernias. More common in women and frequently associated with incarceration/strangulation. Different contents in the hernial sac have been described in the literature, but the ileum accompanied by the adnexa (fallopian tube+ovary, FT/O) has never been described before. Material and Method Case and literature review. Results 62-year-old woman with 48 hours of vomiting and non-reducible right inguinal hernia. Normal blood test and obstruction-patternt x-ray. Exploratory laparoscopy was decided, finding FH with an ischemic intestine in the crural orifice and, unexpectedly, herniated FT/O as well. The elements were reduced – they were viable – and repaired using TAPP with tetanized-low-density-PLP mesh. The course was uneventful and asymptomatic. Conclusions The FH appears inferior to the inguinal ligament, between the Gimbernat and the femoral vessels. Its size and ligamentous-anatomy facilitate incarceration. That they contain the adnexa represent <3% and always in pediatric age associated with genital-anomalies. There are <15 published reports of adult FH with incarcerated FT/O. The concomitance of intestine+adnex has not been previously published. Traditional treatment considers the anterior inguinocrural way, but we prefer the laparoscopic-approach to verify intestinal viability and, in this case, discover infrequently herniated organs. Avoids double incisions (Gregoire+laparotomy) in case of resection and accidental reductions without visualizing the hernia content. The posterior approach is an excellent tool that every emergency-surgeon must control, and in this case, it allowed us to describe – and resolve – the first published case of an atypical hernia.