0:00

Okay, so here's a 75-year-old woman who

0:03

is coming in with nausea and vomiting.

0:05

As we come down here, you can see that we

0:07

have very, very dilated loops of small bowel.

0:10

We can see the mucosa is enhancing nicely, so it's

0:13

not ischemic necessarily, but as we come into the

0:16

lower abdomen and into the groin region on the

0:20

right, we're going to see this knuckle of bowel here.

0:24

So this is a groin hernia causing small

0:27

bowel obstruction, but it is on us to

0:29

determine what type of groin hernia it is.

0:31

As I told you, you're going to draw a horizontal

0:34

line here across from the symphysis pubis from the

0:37

pubic tubercle, and you're going to see that this

0:39

bowel indeed comes out posterior to that line.

0:42

You can see how compressed it is right

0:44

here, has a very narrow neck hernia.

0:46

So you can imagine that this is.

0:47

A pretty, uh, hard hernia to reduce

0:50

coming down, and that is a femoral hernia.

0:53

That's the location of a femoral

0:54

hernia posterior to the pubic tubercle.

0:56

Also, because it goes through the femoral

0:57

hiatus, it is going to have mass effect, meaning

1:00

that it's going to push away the femoral vein.

1:02

Do you see how that femoral vein looks like

1:04

a little bit of a comma, as opposed to the

1:06

round femoral vein on the contralateral side?

1:08

That's because the bowel has herniated through

1:11

there and is pushing that nicely compliant

1:13

vein over, and that is a femoral hernia.

1:15

Let's look at on a coronal.

1:18

You'll see very dilated loops of small bowel.

1:20

You're going to see this very tight hernia sac here

1:23

coming down through the femoral canal with the femoral

1:26

artery, the femoral nerve, and that bowel there.

1:29

This is going to be a different kind of approach.

1:31

Probably will not be able to

1:33

reduce it with physical exam.

1:35

Instead, they will have to

1:35

go on for surgical reduction.

1:37

The surgeons really want to know if they're

1:39

dealing with inguinal or femoral hernias.

1:42

So it's on us to determine that.

1:43

That's your job.

1:44

That's your job.

1:44

Do your job, determine if you have a femoral hernia.