Femoral Hernia Flashcards
What is the epidemiology of femoral hernia?
Uncommon, mostly in female due to wider pelvis
25% will be incarcerated
What are the boundaries of the femoral triangle?
Superior - Inguinal ligament Medial - Adductor longus Lateral - Sartorius Roof - fascia Floor - iliapsoas, pectineus
What is the order of structure in the femoral triangle?
NAVEL
E = empty space (femoral canal)
Femoral artery, vein and lymphatics are within the femoral sheath. Medial part of femoral sheath is the femoral canal
What are the borders of the femoral canal?
Medial - lacunar ligament
Lateral - Femoral vein
Anterior - Inguinal ligament
Posterior - Pectineal ligament
Opening at the superior border is the femoral ring
What runs through the femoral canal?
Empty space for distension of the femoral vein
Lymphatics to drain the lower limbs to the external iliac lymph nodes
What is the clinical presentation of a femoral hernia?
Marble shaped lump in upper thigh below inguinal ligament and medial to femoral artery
High risk of strangulation
No cough impulse
What is the difference between inguinal and femoral hernia?
Herniates through superficial ring vs femoral canal
Superior and medial to pubic tubercle vs inferior and lateral to pubic tubercle
Expansile cough impulse vs no cough impulse
Reducible vs irreducible
Low risk of strangulation vs high risk of strangulation
What investigations for femoral hernia?
CTAP - scared of strangulation
What is the management of femoral hernia?
Lap repair - same as inguinal (TEP or TAPP)
Open
- Infrainguinal (elective)
- Transinguinal (for both inguinal and femoral hernia)
- Suprainguinal (strangulated femoral hernia)
Mesh repair preferred unless a contraindication exists eg. ischemic bowel with perforation
What are the complications of femoral hernia repair?
Similar to hernia repair, with exception of FEMORAL VEIN injury
