Emergency Laparoscopic Transabdominal Preperitoneal (TAPP) Repair With Bowel Resection for a Strangulated Femoral Hernia: A Case Report and Review of Strategies.

Abstract

Femoral hernias are uncommon but carry a high risk of incarceration and strangulation. While laparoscopy is increasingly applied in elective groin hernia repair, its role in emergency settings, requiring bowel resection, remains underreported. We report a 73-year-old woman (BMI 25.8) presenting with acute abdominal pain and vomiting. Examination revealed an irreducible right groin bulge, without overlying skin necrosis. Laboratory tests showed leukocytosis, with a markedly elevated neutrophil-to-lymphocyte ratio (NLR) of 10.7. CT demonstrated a small bowel loop herniating through the right femoral canal, with a mesenteric whirl sign. Diagnostic laparoscopy confirmed incarcerated ileum with a 0.5 cm perforation. Approximately 5 cm of bowel was resected extracorporeally via a mini-laparotomy, followed by transabdominal preperitoneal (TAPP) mesh repair. The patient recovered uneventfully and was discharged on postoperative day 11. Laparoscopic TAPP allowed safe reduction, assessment of bowel viability, correction of mesenteric torsion, and durable hernia repair within the same setting. Current evidence supports mesh use in selected clean-contaminated fields, and our case demonstrates its feasibility, even when limited bowel resection is required. Emergency laparoscopic TAPP repair, with concomitant bowel resection, is a safe and effective option for strangulated femoral hernias, offering both diagnostic and therapeutic advantages while minimizing wound morbidity.