femoral hernia is a type of groin hernia , where the content protrudes through the femoral ring . common contents in femoral hernias are , preperitoneal fat and small bowel , in some rare cases , sac containing an appendix , meckel 's diverticulum , ectopic testis , and stomach are reported . however , a femoral hernia containing the uterus , fallopian tube , and ovary is extremely rare . here , we present a case of femoral herniation of female internal genitalia and review the available literature . a 28-year - old married female patient was admitted to the surgical ward with a painful lump in the left groin . she had the swelling in left groin since 1-year , and it had increased in size recently . although the patient was married for 8 years , she had never conceived and did not have any history of menarche . on general examination , we observed that the patient had normal sized breast and normal external genitalia , however on per - vaginal examination using a vaginoscope , a blind vaginal pouch was observed without any cervix . clinical examination of the lump revealed a 5 cm  5 cm tender , irreducible , nonpulsatile mass in the left groin just under the inguinal ligament [ figure 1 ] . adult female patient with left sided femoral hernia under general anesthesia , an emergency exploration of the femoral hernia was performed . with the classic inguinal approach , incision was given on the skin and carried down through the subcutaneous layers ; the external oblique aponeurosis was opened along with its fibers till the internal inguinal ring was exposed . following this the floor of the inguinal canal ( fascia transversalis ) was opened , and the femoral hernia sac was exposed . after exploration of the mass , we confirmed the diagnosis of the femoral hernia . however , we observed herniation of the uterus , left fallopian tube and ovary [ figure 2 ] . on examination , the contents were observed to be viable and healthy and hence the contents were reduced back into the pelvic cavity . following this the sac was legated at the level of peritoneal cavity and herniorrhaphy was performed using a polypropylene mesh with inguinal ligament and iliopubic tract interiorly , cooper ligament posteriorly , femoral sheath laterally , with the iliopubic tract and lacunar ligament medially with nonabsorbable suture . the patient made good recovery postsurgery and was subsequently referred to the gynecology clinic for management of primary infertility . hernia containing fallopian tube ( a ) , uterus ( b ) , ovary ( c ) the femoral canal is an elliptically shaped inverted cone measuring approximately 2 cm in length and extending from femoral ring to femoral orifice , located just medial to the femoral vessel and it normally contains lymphatic 's , some lymph node ( of cloquet ) and loose adipose tissue . a femoral hernia becomes clinically evident when the normally closed femoral orifice is breached . among the groin hernias , femoral hernias account for 2 - 8% cases , and are mostly observed among adults ( 40 - 70 years ) and are very rarely reported among children . however , it is 2 - 5 times more common among adult females . elevated intraabdominal pressure during conditions such as pregnancy , constipation and bronchitis can displace the preperitoneal fat through the femoral ring and may pull the peritoneum with it to create a sac . in addition , females have wider femoral ring and pregnancy causes further stretching and widening of it which makes them more susceptible to develop femoral hernia . do not progress much in size over time , patients usually ignore it , and suddenly the patient present with painful incarcerated inguinal mass . hence , a general physician should immediately suspect a incarcerated inguinal mass as a femoral hernia , because , likelihood of strangulation of femoral hernia is very high . on clinical examination a typical femoral hernia presents as a tender , nonreducible swelling with no cough impulse and is situated below and laterals to the pubic tubercle . number of investigations such as , contrast herniography , doppler ultrasound , computed tomography scan , are performed for diagnosis , however none of them are more accurately significant than physical examinations ; hence clinical examination remains the gold standard of preoperative diagnosis . among the three basic approaches ( femoral , inguinal and preperitoneal ) to explore the femoral hernia , most surgeons use inguinal approach in the presence of incarceration or strangulation . hence we used the inguinal approach because it provides the excellent exposure of the femoral ring and facilitates the release of the incarceration / or strangulation hernia and gives the opportunity to resect the gangrenous intestine , if required . on exploration , femoral hernia usually contains only omentum or may contain a knuckle of bowel . however , herniation of the uterus , fallopian tube , ovary in a femoral hernia is very rare due to its normal anatomical position as it lies at a lower level than the femoral ring . interestingly in our case we found all internal female genital organs as the content of the hernia . even with extensive search , we have not found such reports , indicating the rarity of this condition . though the acquired theory proposes the mechanism of femoral hernia formation , this theory is unable to explain our case because the patient in this case was young ( 28 years ) and had no history of pregnancy . in addition she also had her internal genitalia inside the femoral canal with a blind vaginal pouch . from our observations , we suspect that , in this case , the hernia may have a congenital etiology although it is very difficult to explain how the internal genitalia got herniated inside the femoral canal . we know testis descends from its embryological position to scrotum by contraction of scrotal tail of gubernaculums ( pubic , perineal , femoral , superficial inguinal tail ) . ovary being a homologous organ of testis , it can migrate at those five possible sites , and in extreme cases ( as in this case ) , it may draw the female internal genitalia with it . as the femoral canal is very narrow and poorly expandable , the normal growth of the uterus was not possible , which possibly explains the infertility in our patient . femoral hernia is more common among adult females , and it may present with strangulation . diagnosis is made by clinical examination , and urgent surgical exploration should be performed in such cases . mostly the hernial content is preperitoneal fat , but rarely like in our case internal female genitalia can also be observed .
we report a rare case with herniation of the uterus , fallopian tube , and ovary in a femoral hernia . 
 a female patient was admitted with complain of the painful lump in the left groin . 
 clinical examination indicated strangulated femoral hernia , which necessitated an emergency surgery . during surgical procedure , the uterine tube , left fallopian tube and left ovary , were observed as the contents of the hernia . 
 the contents were reduced back into the pelvic cavity , and the hernia was repaired . 
 the patient made good recovery postsurgery .