A 49-year-old male presented with a swelling in his right inguinal region that had developed over 4 years. He reported pain in the area for the past 15 days. On examination, a 2.5x2.5cm globular, non-reducible swelling was found in the right femoral region. Ultrasound revealed an irreducible right femoral hernia that was not obstructed. The patient underwent open surgery using the Lockwood approach under spinal anesthesia, where a right femoral hernia containing approximately 20ml of peritoneal fluid was found and repaired.

2. A49yrsmale pt residing in Thatta,labourbyoccupation,presented
at Surgery-OPDwith
Chiefcomplaints:-
 Swellingon right inguinal region since4yrs.
 Painfor 15days

3.  Swelling on right inguinal region:-
 Since4 yrs.
 Develops spontaneously.
 Associated with pain.
 Grows slowly.
 Not a/w fever, ulceration, loss ofbody weight and
swelling is single.

4. 






At rt.inguinal region.
Insidious onset.
Pin pricking.
Radiates toward thigh.
Aggravated by standing & weightlifting.
Relief by rest on supineposition.
Painis mild.

5. Pasthistory:-
 Nosignificantpastmedical( like:-chroniccough,constipation and
retention of urine )andsurgicalhistory in past.
Personalhistory:-
 Patient isnon-alcoholic,non-smoker,non-vegetariandiet.
Familyhistory:-
 Nosignificantfamilyhistory.
 Eightmember family with five kids.

6.  Generalcondition –fair
 Jaundice
 Anemia
 Cyanosis
 Clubbing
 Lymphadenopathy
 Edema
 Wellhydrated
Vitalsigns:-
B.P.- 110/70 mm ofHg.




Pulse–76beats/minute –regular.
Temperature–98.F
RR–18breathe / minute
Spo2–98%
Not found

7. Chest:-normal vesicularbreathe soundpresent.
CVS:- S1+S2+0
CNS:- grosslyintact.
Perabdomen:-
 Inspection:-
 Scaphoidshape.
 Umbilicusinverted andcentrallylocated
 All quadrants movesequally withrespiration.
 Visiblepulsation andperistalsisareabsent.
 Protrusion from right sidedsaphenousopening.

8.  Onpalpation:-
 Nolocalizeriseof
temperature.
 Notenderness.
 Noorganomegaly
detected.
 Onpercussion:-
 Tympanicsoundfound.
 OnAuscultation:-
 Bowelsoundpresent –3/ minute.

9.  Onstandingposition:-
 Inspection:- singleswelling
- at upper –medialthigh.
- coughimpulsepresent.
- similar to skincolor.
- globular.
- 2.5x2.5cm
- well definededge.
- no pulsation &peristalsis.
- no movewithrespiration.
- skinover swellingnormal.
 Onsupineposition:-
 Thereisno alterationof
shapeandsizeof the
swelling i.e. similar to
standingposition.

10.  Palpation:-
- Nolocalizerise oftemperature.
- Notenderness.
- Size2.5x2.5cm,globular.
- Smoothsurface.
- Coughimpulse present.
- Distinct edgebut not palpable upperedge.
- Firmconsistency.
- Nonfluctuating.
- Nofluid thrill.
- Nontranslucent.
- Nonreducible.
- Compressible.
- Nonpulsatile andnot fixed tooverlying skin.

11.  onpercussion:-
- Dull onpercussion.
 OnAuscultation:-
- Nobruits.
- Nogurglingandbowelsound.

12.  TLC–8200 Hb–13.5 ESR–10
 RBS–80 Urea–31 Creatinine–1.0
 Na+- 145 K+-4.1
 BT–2’15” CT–7’30” PT/INR–13”/1.0
 Serology–negative
 Urine R/E–Puscell–12to 14
- Epithelialcell–1to3
- RBC–nil
 U/SAabdomenandpelvis.
- RightFemoralHernia.

13. - Irreducible RightFemoralHernia( Non–obstructed).
Differentialdiagnosis:-
 Rt.inguinalhernia.
 Rt.inguinallymphnode.
 Lipoma.
 Psoasabscess.
 FemoralArteryAneurysm.

14.  Opensurgery–LOCKWOODapproachunder Spinal
Anesthesia.
 Intra operative findings are:- Rt.femoral hernia withperitoneal
fluids approx.amount 20ml

16. Boundaryof femoralcanal:-
 Supero-anteriorly:-
Inguinalligament.
 Infero-posteriorly:-
Iliopectinealligament
(cooper)
 Medially:- Lacunarligament
( Gimbernatsligament).
 Laterally:-femoralvein

22.  Usuallypresentswith painor discomfortin groin.
 Groinlump.
 Usuallynot reducible.
 Mild pain exacerbatedbybendingorlifting.
 Mild tenderness.
In caseof obstruction:-
 Colickyabdominalpain.
 Vomiting,constipation
 Abdominaldistension.
 Lumpirreducible andtender.

23.  Lumpisverytender.
 Skinover the lump red andhot.
 Featuresof shock.

24.  HistoryandClinicalexamination.
 Ultrasonography–abdomenandpelvis.

25.  Inguinalhernia.
 Saphenavarix.
 Lipoma.
 Femoralarteryaneurysm.
 Psoasabscess.
 Ectopictestis.