72 year old woman hypertensive with right ventricular insufficiency presented to the hopsital with right groin swelling of several months duration. apart from occasional discomfort felt in the groin she had no obstructive symptions an felt no severe pain. patient was on her usual antihypertensives medications and the blood pressure was controlled. she had one caesarean section during her reproductive years.
stable patient , short stature,
Vital signs were essentially normal.
Chest was clear . No abnormal heart sounds normal. abdomen was soft . shifting dullness present . median lower abdominal scar of previous surgery healthy. Rt femoral region had a swelling measuring 8*8cm non pulsatile. mass was nontender and completely reducible with redundant skin folds in its place. There were prominent superfical branch of inferior epigastric veins, circumflex iliac veins.
Diagnosis : reducible right femoral hernia made
Investigations : Abdominal USG confirmed the presence of mild ascities, mild enlargement of the liver with no probe tenderness all other findings were normal.
Blood counts , urine routine examinations were normal
Treatment : Surgical repair of the hernia was suggested to the patient to which she complied.
Anaesthesia was subarachoid block using 2mls of 0.5% heavy marcaine.Abdomen and groin was prepared routinely and draped. A direct approach to hernia was chosen using 5cm transverse skin incision. Sac was mobilised and high ligated . The defect repaired by with nonabsorbable suture placed between pectineus fascia and inguinal ligament . Redundant subcutaneous tissue noted in surgical field . Careful dissection of which revealed a saphena varix. Redundant subcutaneous tissue which resembled a sac was actually loose areolar tissue covering the varix. Ligation of all confluences close to the saphenofemoral junction done. The great sphenous vein ligated flush with the common femoral vein. the dilated portion of the saphenofemoral vein removed after double liagtion of proximal part. Routine closure of wound done.
Post operative reviews
Patient made excellent recovery and was discharged home on diuretics . She was asked to continue on her routine antihypertensives . Subsequent reviews of the surgical site was normal. Tissue oedema of the lower limbs resolved with maintenance doses of diuretics
Femoral hernias are rare but not uncommon in females . masses that have been documnted to be found at in the femoral triangle during surgery include lipomas, enlarged lymph node of Cloquet, coesting Mullerian and renal malformation. A careful dissection of the triangle is essential as other structures can masquerade as femoral hernia. While the aforementioned structures may be encountered in the femoral region during surgery, femoral hernia coexisting with a saphena varix is rare