When a 41-year-old woman reported to the emergency room because of sudden pain in her groin, doctors discovered a rare condition that required surgery right away: a femoral hernia that contained an “incarcerated ovary.” The details of her case were published this week in BMJ Case Reports.
Well, that sounds terrifying. But what exactly do those terms mean, and why was her condition so serious? First things first: A hernia occurs when part of an organ or tissue bulges through an opening in a muscular wall, usually in the abdomen. A femoral hernia, then, is such a bulge related to the femur—or thigh bone—or the muscles and tissues around it—usually in the upper thigh or groin area.
Then there’s the matter of the above-mentioned incarcerated ovary, which means that the herniated tissue had somehow wrapped itself around the woman’s reproductive organs.
The report references a “plum-sized” mass that had caused the patient considerable pain over the past 24 hours. When she went to the emergency room, she told doctors she felt nauseous, although she hadn’t vomited and her bowel patterns hadn’t changed.
Her doctors found a mass that was 4 centimeters long and “firm, well circumscribed and exquisitely tender,” according to their report.
Both gynecological experts and emergency room doctors participated in the woman’s treatment. General surgeons should be able to treat groin hernias that contain an incarcerated ovary, the report notes—but having gynecologic experts present might be helpful, it adds.
When the patient was taken to the operating room, the doctors noticed that “the ovary appeared viable, although it was not easily manipulated and appeared under extreme tension.”
The treatment for groin hernias (also called inguinal hernias) varies depending on its size, according to the Mayo Clinic. If it’s small and isn’t causing pain, doctors may recommend against surgery and opt to just keep an eye on it.
Painful or growing hernias typically require surgery so that discomfort and serious complications are avoided, the Mayo Clinic says. Sometimes, a doctor might apply manual pressure to a groin hernia in an attempt to make it smaller before surgery is performed. (This is most commonly done for children with hernias.).
Hernias are usually repaired in one of two ways—via open surgery, which involves one large incision, or laparoscopic surgery, which involves multiple small incisions.
The patient featured in the new report did not have a laparoscopic surgery. But her doctors wrote that, in retrospect, they think a laparoscopic operation might have been a possible approach to treatment.
Open hernia surgery can require the use of sedation and local or general anesthesia. During the operation, the surgeon will push the bulging tissue back into place and then sew up the weak area of the muscle wall.
Sometimes—as was the case for the BMJ patient—a synthetic mesh is inserted to reinforce this area. In this case, doctors also inserted a tiny laparoscopic camera during surgery “to help visualize the pathway of the ovary back into the pelvic cavity.”
Luckily, the patient made an “excellent recovery” and was discharged within one day of her surgery. When interviewed for the case report, she said she was “shocked” by how quickly her doctors rushed to operate, but that in the end, it was the right call. “I was thankful that the team were able to save my ovary,” she said.