Femoral Hernia

Question 1

The femoral triangle is a conduit/channel that allows important structures to pass through. The mnemonic SAIL can be used to remember the lateral, medial and superior borders. What are the 3 structures that make up the lateral, medial and superior borders?

1 - sartorius muscle, adductor longus, inguinal ligament
2 - sartorius muscle, adductor brevis, inguinal ligament
3 - sartorius muscle, adductor magnus, inguinal ligament

Answer 1

1 - sartorius muscle, adductor longus, inguinal ligament

• S = sartorius
• A = adductor longus
• IL = inguinal ligament

Question 2

The femoral triangle is a conduit/channel that allows important structures to pass through. There are 4 main things that pass through. Using the mnemonic NAVL, which also signifies the order of the contents from lateral to medial, what passes through the triangle?

Answer 2

• N = femoral Nerve
• A = femoral Artery
• V = femoral Vein
• L = lymphatics

Question 3

The femoral triangle is a conduit/channel that allows important structures to pass through. The mnemonic SAIL can be used to remember the lateral, medial and superior borders.

• S = sartorius
• A = adductor longus
• IL = inguinal ligament

PIC can be used to identify the remaining floor and roof borders. What are the remaining roof and floor borders?

1 - Pectineus, iliacus, Cribriform
2 - Pectineus, Iliopsoas, Cribriform
3 - Psoas, iliacus, Cribriform
4 - Psoas, Iliopsoas, Cribriform

Answer 3

2 - Pectineus, Iliopsoas, Cribriform

- Cribriform also known as fascia lata

Question 4

The femoral triangle is a conduit/channel that allows important structures to pass through. This is a good place for assessing which pulse?

1 - femoral
2 - renal
3 - popliteal
4 - obturator

Answer 4

1 - femoral

• located by using mid inguinal point

Question 5

The femoral triangle is a conduit/channel that allows important structures to pass through. In addition to the femoral nerve, vein and artery that pass through the femoral triangle, there is also another vein that is able to pass through an opening in the fascia lata. What is this vein called?

1 - pectinous vein
2 - great saphenous vein
3 - tibial vein
4 - obturator vein

Answer 5

2 - great saphenous vein

Question 6

Inside the femoral triangle there is also the femoral canal. Why is this of important clinical significance?

1 - weakest point
2 - strongest point
3 - contains important lymph nodes
4 - contains the great saphenous vein

Answer 6

1 - weakest point

• point of herniation in a femoral hernia

Question 7

The femoral canal is an important landmark as this is a weak point of the femoral triangle and is the location of femoral hernias. FLIP can be used to remember the borders of the femoral canal. Use the labels below to identify the medial, lateral, anterior and posterior borders of the canal.

• Pectineal ligament
• Femoral vein laterally
• Inguinal ligament anteriorly
• Lacunar ligament medially

Answer 7

• medial = Lacunar ligament
• lateral = Femoral vein
• anterior = Inguinal ligament
• posterior = Pectineal ligament posteriorly

Question 8

What does the femoral canal contain?

1 - spermatic cord
2 - great saphenous vein
3 - femoral artery
4 - lymphatics

Answer 8

4 - lymphatics

Question 9

Femoral hernias, which is when there is a protrusion of the peritoneum into the femoral canal, accounts for 3% of all hernias. The majority (60%) occur on the left or right side?

Answer 9

• right
• likely to be due to slower development of processus vaginalis on the right side

Question 10

Are femoral hernias more common in men or women?

Answer 10

• women
• 2:1

Question 11

Which 2 of the following are the most common risk factors for femoral hernias?

1 - connective tissue disorder
2 - increased abdominal pressure
3 - previous surgery
4 - BMI

Answer 11

1 - connective tissue disorder
2 - increased abdominal pressure

• twice as common in parous (women who have given birth) women

Question 12

A femoral hernia travels through the femoral canal. Why is the risk of strangulation at 20-40% high in these hernias?

1 - inguinal ligament is weak here
2 - increased abdominal pressure located here
3 - narrow and inflexible ring
4 - femoral artery increases pressure

Answer 12

3 - narrow and inflexible ring

• 3 sides of femoral canal are inflexible:

Inguinal ligament anterior
Pectineus/pectineal ligament posterior
Lacunar ligament medial

Question 13

Femoral hernias typically present in all of the following EXCEPT which one?

1 - extreme pain
2 - bowel disturbance
3 - blood in stool
4 - palpable lump

Answer 13

3 - blood in stool

• lumps may be irreducible
• may find femoral hernia as an incidental finding

Question 14

What of the following are medical emergencies in a patient with a suspected femoral hernia?

1 - incarceration
2 - strangulation
3 - pain
4 - previous surgery

Answer 14

1 - incarceration
2 - strangulation

• both need operating on asap
• beware bowel obstruction and virgin abdomen (no previous surgery)

Question 15

Which of the following is true about femoral hernias?

1 - above and medial to pubic tubercle
2 - above and lateral to pubic tubercle
3 - below and lateral to pubic tubercle
4 - below and medial to pubic tubercle

Answer 15

3 - below and lateral to pubic tubercle

• above and medial to pubic tubercle is for the external inguinal ring

Question 16

Which of the following is not a common differential for a femoral hernia?

1 - lipoma
2 - inguinal hernia
3 - appendicitis
4 - cloquet lymph node

Answer 16

3 - appendicitis

• femoral hernias are relatively fixed so we can identify them this way

Question 17

If a femoral hernia is suspected, which of the following imaging modalities is most likely to be used to support clinical examination?

1 - CT
2 - MRI
3 - X-ray
4 - ultrasound

Answer 17

4 - ultrasound

• CT and MRI use is rare

Question 18

Surgery is generally preferred in the following:

1 - emergency if risk of strangulation
2 - elective if patient is stable
3 - conservative management if patient is unfit for surgery

Answer 18

• need to be treated once found, regardless of if they are asymptomatic