Missed Diagnosis: Case of Strangulated Femoral Richter’s Hernia in an Elderly Woman

Femoral hernias are rare but can occur and sometimes present with strangulation because of the narrow opening in the femoral canal. They are commoner in elderly women, and sometimes the diagnosis could be missed. We managed the case of a 77-year-old woman who was said to have undergone a "repair of an inguinal hernia" at a private hospital where she presented with a strangulated groin swelling. However, symptoms of bowel obstruction persisted post-operatively, necessitating the referral to our facility. On presentation, she was resuscitated, and intra-operative findings revealed a strangulated Richter's femoral hernia. A wedge resection and anastomosis was done and the hernia defect repaired. She improved well and was subsequently discharged. Thus, the finding of complicated groin swelling should heighten the suspicion of the attending surgeon for a femoral hernia and provoke a detailed clinical examination so as to prevent delay in diagnosis, provide prompt intervention, and improve clinical outcomes. This is important particularly in our setting where hernia repairs are the most common surgeries done, yet advanced imaging modalities are not always accessible for accurate pre-operative diagnosis.