Twice-recurrent Inguinal Hernia Masquerading as a Femoral Hernia in a 76-Year-Old Male: A Case Report and Review of the Literature

Abstract

Introduction: Recurrent inguinal hernia presenting through the femoral canal is an underappreciated phenomenon that poses significant diagnostic and operative challenges. We report a case in which a twice-recurrent left inguinal hernia in an elderly man was preoperatively misclassified as an incarcerated indirect inguinal hernia with bowel involvement; intraoperative exploration revealed an additional femoral component, and both defects were managed successfully through a single open approach. Case Presentation: A 76-year-old man presented with a painful, irreducible left groin swelling. He had undergone two previous left inguinal hernia repairs without mesh, the most recent approximately 12 years earlier. Preoperative ultrasonography reported an indirect inguinal hernia with incarcerated bowel. Intraoperatively, extensive adhesions were encountered; after meticulous dissection, the cord structures were identified, but no indirect hernial sac was found. The posterior inguinal wall was weak. A separate 3 cm swelling was noted below the inguinal ligament, entering through the femoral canal and containing only preperitoneal fat. Both defects were repaired: the posterior inguinal wall was reconstructed with polypropylene sutures and reinforced with mesh, while the femoral defect was managed by excision of the fat, reduction, and placement of a 5 × 5 × 5 cm polypropylene mesh plug. Conclusion: A recurrent inguinal hernia can present through the femoral canal when a prior repair has failed to address the full extent of the myopectineal orifice of Fruchaud. Surgeons must maintain a high index of suspicion for a femoral component in all recurrent groin hernias, particularly after non-mesh tissue repairs. Thorough intraoperative exploration of both the inguinal and femoral spaces is essential to avoid missed defects.