The strangulated femoral hernia classically presents with colicky abdominal pain and signs of intestinal obstruction - distension, vomiting, and constipation. Often, localising symptoms are absent and there is more discomfort in the abdominal region than in the femoral area. In 30% of cases, a Richter's hernia occurs in which only part of the bowel circumference is trapped in the hernial sac. Symptoms of bowel obstruction are absent although the trapped knuckle of bowel may become necrotic and even perforate into the hernial sac and thence, the peritoneal cavity.
The diagnosis of a strangulated femoral hernia is easily missed unless the patient is examined for a grape-sized lump immediately below the inguinal ligament and just lateral to its medial attachment to the pubic tubercle.
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