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Obstructed or strangulated femoral hernia — MSRA MCQ

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HardHip and GroinObstructed or strangulated femoral herniaMSRA

A 76-year-old woman presents to her GP with 7 hours of worsening right groin pain. It began after lifting a heavy shopping bag and is now associated with colicky lower abdominal pain and three episodes of vomiting. She has no previous hernia history. She is uncomfortable, with a temperature of 37.4°C, pulse 104 beats/min and blood pressure 138/76 mmHg. There is a 3 cm firm, exquisitely tender, non-reducible lump inferior and lateral to the right pubic tubercle. It has no cough impulse. Her abdomen is mildly distended but soft, with no guarding. Hip flexion and rotation are full and painless. What is the most appropriate immediate management in primary care?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Keep her nil by mouth and arrange emergency transfer to hospital for suspected obstructed or strangulated femoral hernia

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · A = shown as D

This is a surgical emergency. The lump is inferior and lateral to the pubic tubercle, supporting a femoral rather than inguinal hernia. Her older age and sex also increase the likelihood of femoral hernia. The key escalation features are a firm, tender, irreducible lump with colicky abdominal pain, vomiting, distension and tachycardia: these indicate bowel obstruction and raise concern for strangulation. She requires immediate hospital assessment and should be kept nil by mouth; primary-care imaging must not delay transfer. Femoral hernias have a high complication risk, and obstruction or strangulation requires emergency surgery. ([nhs.uk](https://www.nhs.uk/tests-and-treatments/femoral-hernia-repair/?utm_source=openai)) A is inappropriate because diagnostic uncertainty does not justify delaying emergency assessment in a clinically obstructed hernia. B is unsafe in primary care: attempted reduction may be considered only in carefully selected patients after emergency surgical assessment, not where obstruction or possible strangulation is present. D would be appropriate for an uncomplicated symptomatic femoral hernia that is reducible and without obstructive symptoms. E is distracted by groin pain, but painless hip movement and the focal irreducible groin mass make a hip source unlikely.

Reference: Femoral hernia repair (Page last reviewed 11 January 2022) — https://www.nhs.uk/tests-and-treatments/femoral-hernia-repair/ Hernia (Accessed August 2026) — https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit-in-development/colorectal/hernia/