A Case of Femoral-type Sacless Hernia Treated by Totally Extraperi Toneal Repair

Abstract

A 21-year-old man presented with right groin pain. Contrast-enhanced abdominal computed tomography (CT) demonstrated fat protrusion through the right femoral ring, raising suspicion of a femoral hernia or preperitoneal fat herniation. Diagnostic laparoscopy revealed no evidence of true femoral hernia. Subsequent exploration via a totally extraperitoneal approach identified the incarceration of preperitoneal fat within the femoral ring. The incarcerated fat was reduced, and mesh repair was performed. The patient's pain resolved promptly postoperatively. The absence of a peritoneal sac indicates a sacless hernia. To date, including the present case, only seven cases of sacless hernias involving the femoral ring have been reported. Clinically, a sacless hernia mimics femoral hernia. In patients aged <70 years or in those with imaging evidence of fat protrusion into the femoral ring on CT or ultrasonography, a sacless hernia should be considered in the differential diagnosis, for which diagnostic laparoscopy is recommended. In five cases where laparoscopy was performed, the findings varied, highlighting the need for exploration of the preperitoneal space when no femoral hernia is found.