Femoral Hernia

Question 1

Prevalence & patient demographics

Answer 1

Prevalence
Uncommon 5% of all abdo hernias
Slender, middle-aged/older females

Question 2

Clinical Presentation

Answer 2

Lump in groin lateral & inferior to pubic tubercle
May be possible to reduce hernia on examination
Associated lower abdo pain if incarceration occurs

Question 3

Signs

Answer 3

Place fingers over femoral canal and get patient to cough- femoral hernia remains reduced, inguinal hernia reappears as swelling
Disappears/reduces when supine or relaxed

Question 4

Differentials

Answer 4

Lymphadenitis
Incaarcerated femoral hernia
Hydrocele/ varicocele
Inguinal hernia
Psoas abscess/bursa
Saphena varix
Spermatic cord hydrocele
Femoral canal lipoma

Question 5

Investigations

Answer 5

Clinical & groin examination

Imaging: Helpful- USS first line then CT/MRI

Question 6

Management

Answer 6

Surgery: 1)Lockwood’s- Low approach 2)Lotheissen’s-Trans-inguinal 3)McEvedy’s- High approach
Elective surgery is the first option due to risk of strangulation

Question 7

Prognosis

Answer 7

Elective surgery-low mortality, emergency surgery- mortality x7 higher

Question 8

Complications

Answer 8

Strangulation-most common
Recurrence
Post-op intestinal obstruction
Surgery- scarring, bleeding

Question 9

How are hernias classified?

Answer 9

Reducible, irreducible, obstructed, strangulated

Question 10

Risk factors

Answer 10

Female
Middle-aged/ elderly
Obesity
Pregnancy
Inc intra-abdo pressure: heavy lifting, chronic constipation

Question 11

Definition

Answer 11

Abnormal protrusion of a loop of intestine into the femoral canal, a tubular passageway that carries nerves and blood vessels to the thigh

Question 12

Causes

Answer 12

Constipation
Carrying/pushing heavy loads
Obesity
Chronic, heavy cough