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Femoral hernia — MSRA MCQ

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HardHip and GroinFemoral herniaMSRA

A 54-year-old woman presents with a 3-month history of an intermittent right groin lump. It becomes apparent after prolonged standing or lifting and reduces when she lies down. She has mild local discomfort but no vomiting, abdominal distension, constipation, fever or systemic upset. Examination standing shows a 2 cm soft, reducible swelling with a cough impulse, located inferior and lateral to the right pubic tubercle. The abdomen is soft and non-tender. Hip movements are full and painless. She is not pregnant. What is the most appropriate next step in primary care?

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

Reveal the answer and explanation

Correct answer: A — Make an urgent surgical referral for suspected femoral hernia and give emergency safety-netting advice

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

This is a suspected femoral hernia: the swelling lies inferior and lateral to the pubic tubercle. Although it is reducible and there are no obstructive or systemic features, femoral hernias have a higher risk of complications than inguinal hernias and repair is generally recommended without delay. In women, a clinically apparent groin hernia also warrants particular caution because femoral hernias are relatively more common and may be mistaken for inguinal hernias. Urgent surgical assessment is therefore appropriate, with clear advice to seek emergency care if the lump becomes irreducible or increasingly painful, or if vomiting, abdominal distension or obstructive symptoms develop. B is attractive because the lump is reducible and symptomatic, but it incorrectly treats this as a low-risk inguinal hernia and understates the required urgency. C is unnecessary where examination is diagnostic; imaging should not delay referral of a suspected femoral hernia. D may be considered for selected minimally symptomatic inguinal hernias, principally in men, but not for a suspected femoral hernia in a woman. E would be correct if there were irreducibility, marked tenderness, obstruction, peritonism or systemic deterioration suggesting incarceration or strangulation.

Reference: NHS: Femoral hernia repair (2022) — https://www.nhs.uk/tests-and-treatments/femoral-hernia-repair/ International guidelines for groin hernia management (2018) — https://pubmed.ncbi.nlm.nih.gov/29330835/