Femoral hernia Flashcards
What is a femoral hernia?
Abdominal viscera (bowel) or omerntum passes through the femoral ring and into the femoral canal, presenting as a mass in the upper medial thigh or above the inguinal ligmanetwhere it points down the leg.
Who does femoral hernia normally occur in?
Middle age and elderly women
Because of the wider anatomy of the female bony pelvis.
Describe the femoral canal, its borders and contents.
Anterior border - inguinal ligament
Medial borders - lacunar ligament and pubic bone
Lateral - the femoral vein and iliopsoas
Posteriorly: the pectineal ligament and pectinous
Superior border - femoral ring (rigid)
Canal contains lymphatic vessels, lymph nodes and some loose connective tissue
What are risk factors for femoral hernia?
Female
Increasing age
Pregnancy
Increased intra-abdominal pressure - chronic constipation, chronic cough, heavy lifting
How do femoral hernias usually present?
Lump in the groin
30% as emergency due to obstruction/strangulation due to rigidity of the femoral canal.
Asymptomatic aside from lump in the groin
How do you differentiate a femoral hernia from inguinal hernia?
Femoral is inferolateral to pubic tubercle and medial to femoral pulse
Inguinal is superomedial to the pubic tubercle
What are differentials for lump in groin?
Low inguinal hernia Femoral canal lipoma Femoral lymph node Saphena varies (dilation of saphenous vein where it enters the femoral vein) - this disappears when lying flat and a thrill is palpable when coughing Femoral artery aneurysm
What investigations for femoral hernia?
Gold standard - USS
How are femoral hernias managed?
Surgically due to increased risk fo strangulation (relative to inguinal hernia)
Reduction of hernia and surgical narrowing of the femoral ring
Low approach - incision below inguinal ligament - does not interfere with inguinal structures
High approach - above inguinal ligament - easy access to compromised small bowel
Complications fo femoral hernia?
Strangulation
Irreducible/obstruction
