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Incarcerated femoral hernia with suspected bowel obstruction/strangulation — MSRA MCQ

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HardHip and GroinIncarcerated femoral hernia with suspected bowel obstruction/strangulationMSRA

A 78-year-old woman presents to her GP with 6 hours of rapidly worsening right groin pain. For several weeks she has noticed a small intermittent lump at the top of her thigh that disappeared when she lay down. Today it became painful and has not reduced. She has vomited once and has not passed flatus since the pain began. She is uncomfortable but alert. Temperature is 37.4°C, pulse 98 beats/min and blood pressure 138/76 mmHg. Abdominal examination shows mild distension without guarding. There is a tense, exquisitely tender 3 cm lump below and lateral to the pubic tubercle, with no cough impulse and no overlying skin change. Passive hip movements are full and painless. What is the most appropriate next step in general practice?

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Correct answer: E — Arrange emergency transfer to hospital for immediate surgical assessment

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

This is a likely incarcerated femoral hernia with bowel obstruction and possible strangulation. The lump lies below and lateral to the pubic tubercle, supporting a femoral rather than inguinal hernia. Its previous reducibility followed by persistent irreducibility, marked tenderness, vomiting and failure to pass flatus indicate that bowel may be trapped. Normal skin colour, absence of peritonism and relative haemodynamic stability do not safely exclude evolving strangulation. Femoral hernias have a high risk of complications. Obstruction causes nausea, vomiting, abdominal pain and a painful groin lump; strangulation requires emergency surgery within hours. Emergency hospital transfer for immediate surgical assessment is therefore required. A is inappropriate because imaging must not delay surgical assessment where incarceration or strangulation is suspected. B underestimates the time-critical risk. D is unsafe in this primary-care setting because strangulation cannot be excluded and attempted reduction could delay definitive assessment. E would be appropriate for an uncomplicated, reducible femoral hernia, but not for this acute presentation.

Reference: Femoral hernia repair – Overview (Page last reviewed 11 January 2022; checked 16 August 2026) — https://www.nhs.uk/tests-and-treatments/femoral-hernia-repair/ Hernia (Page last reviewed 19 May 2026) — https://www.nhs.uk/conditions/hernia/?src=conditionswidget