BILATERAL FEMOROCELE : FIRST CASE EVER REPORTED

Volume : VII, Issue : X, October - 2018

Dr. Kalpit Goriwal, Dr. Adheesh Goriwal, Dr. Sunil Kaul

INTRODUCTION :

Hydrocele of femoral hernial sac is an extremely rare entity. Total six authentic cases have been recorded till date.

Bailey [1] reported the 􀃶rst case in 1927; Rives [2] in 1934 had reported two cases of true femoral hydrocele. The femoral canal is located

below the inguinal ligament, lateral to the pubic tubercle; bounded by the inguinal

ligament anteriorly, pectineal ligament posteriorly, lacunar ligament medially, and the femoral vein laterally. It normally contains a few

lymphatics, loose areolar tissue and occasionally a lymph node called Cloquet�s node. Femoral hernia develop as herniations of the

peritoneal sac through the femoral ring into the femoral canal, medial to femoral vessels. The femoral hernia sac have been reported

commonly consisting of omentum or small bowel. Fluid collection in femoral hernia sac from peritoneal cavity gravitated to pouch and

omental plug at narrow neck. Fluid amber color and sterile in nature, with presence of albumin and 􀃶inogen. In old age, the femoral

defect increases and femoral hernia is commonly seen in low-weight, elderly females seen in women at 4th to 6th decade. Clinical

presentation�painless groin swelling. This never has been diagnosed preoperatively in all cases reported in literature but always only after

surgical exploration, as in our case too. The differential diagnosis in consideration is only as irreducible or incarcerated femoral hernia or cyst

of the canal of Nuck, subcutaneous lipoma or Bartholin�s cyst of labium majora, lymphadenopatheic abscess, or arterial and venous

aneurysms.

Hydrocele of femoral hernia sac: two varieties, i.e.,

i. Primary or true hydrocele of femoral hernia sac: 􀃸uid trapped in the sac of femoral hernia either due to adhesions or omental plugging at

narrow neck of sac, with no evidence of ascites.

ii. Secondary: 􀃸uid collection in sac of femoral hernia from the peritoneal cavity.

The use of mesh is still debatable. Primary tissue repair has been recommended by most studies, particularly if no tension or risk of wound

infection.