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Arch Surg. 1942;44(5):933-942. doi:10.1001/archsurg.1942.01210230157011.
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Strangulation is the most frequent and most serious complication of femoral hernia. Fourteen per cent of two hundred and twenty-two femoral hernias (31 patients) were strangulated on admission of the patients to the University Hospitals, and an additional 23 per cent had been strangulated on previous occasions. Thirty-two per cent of the patients with strangulated hernias died, and 42 per cent had serious postoperative complications. However, only 1.3 per cent of the patients whose hernias were not strangulated died.

ETIOLOGIC FACTORS  The small size, the rigidity and the horizontal placement of the femoral ring (fig. 1) account for the frequency of strangulation as well as for the tendency toward early development of gangrene.Any sudden increase in the intra-abdominal tension may cause strangulation. The most common precipitating factors in the cases at University Hospitals were heavy lifting, excessive straining, vomiting, falling, parturition, constipation and trauma to the abdomen.Irreducibility, obstruction


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