One possibility on discovering strangulation during high or low approaches to femoral hernias is attempting to deal with the ischaemic tissue through the same approach.
The sac should be defined and its lateral wall opened; this avoids the risk of damage to the anterolateral wall of the bladder which can occasionally form the medial wall of the hernia. Any fluid within the sac is aspirated and sent for microscopy and culture. The contents of the sac are carefully delineated by gentle dissection back to the neck. Usually, it is possible to determine the cause of any constriction e.g. oedema of the sac contents. To relieve the constriction, it may be necessary to excise extraperitoneal fat or retract the inguinal ligament and femoral vein.
Any viscera found to be ischaemic are wrapped in warm saline packs and left for 5-10 minutes. Small areas of necrosis of the small bowel may be treated by oversewing. If large segments of the bowel are ischaemic, it may be possible to deliver proximal and distal bowel into the wound, excise the non-viable segment and undertake anastomosis through the same site.
Non-viable tissue should never be reduced back into the peritoneal cavity.
Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page