Femoral hernia

Question 1

Define a hernia.

Answer 1

The protrusion of a viscus or part of a viscus through a defect of the wall of its containing cavity into an abnormal position (any structure passing through another so ending up in the wrong place).

Question 2

What is the epidemiology of a femoral hernia?

Answer 2

· Accounts for 5% of abdominal hernias.
· More common in women.
· Often presents acutely with incarceration or strangulation.

Question 3

What is the pathophysiology of a femoral hernia?

Answer 3

· A femoral hernia - bowel follows the tract below the inguinal ligament through the femoral canal.
· The canal lies medial to the femoral vein and lateral to the Lacunar ligament.
· Femoral hernias protrude through a small defined space, and so can easily become incarcerated/strangulated.
· Presenting as a mass in the upper thigh, or above inguinal ligament where it points down the leg.

Question 4

What does the prognosis of a femoral hernia look like?

Answer 4

· Surgery is the only cure. If done promptly before complications, prognosis is full recovery.
· If bowel necrosis occurs and subsequent organ failure, prognosis is poor. This is rare.

Question 5

What is the aetiology of a femoral hernia?

Answer 5

· An enlarged femoral ring.

· Bowel enters femoral canal.

Question 6

What are the risk factors for a femoral hernia?

Answer 6

· Female - due to wider bone structure of female pelvis.
· Increasing age.
· Pregnancy.
· Increased intra-abdominal pressure - heavy lifting, chronic constipation.

Question 7

What are the signs and symptoms of an asymptomatic femoral hernia?

Answer 7

· Swelling or fullness at hernia site.
· Aching sensation.
· No true tenderness O/E.
· Enlarges with increasing intra-abdominal pressure and/or standing.

Question 8

What are the signs and symptoms of an incarcerated femoral hernia?

Answer 8

· Painful enlargement of a previous hernia or defect.
· Can’t be manipulated.
· Nausea, vomiting and possibly symptoms of bowel obstruction.

Question 9

What are the signs and symptoms of a strangulated femoral hernia?

Answer 9

Systemic toxicity if ischaemic bowel.

Question 10

What investigation is used to diagnose a femoral hernia?

Answer 10

USS.

Question 11

What are the differential diagnoses?

Answer 11

· Low presentation of an inguinal hernia.
· Femoral canal lipoma.
· Femoral lymph node.
· Femoral artery aneurysm.

Question 12

What are the current treatment options for a femoral hernia?

Answer 12

Surgery. Increased risk of strangulation relative to inguinal hernias:

• Reduction of the hernia.
• Surgical narrowing of the femoral ring.

All femoral hernias should be repaired due to risk of strangulation.

• Herniotomy = ligation and excision of the sac
• Herniorrhaphy = repair of hernia deficit

Question 13

What complications may arise?

Answer 13

· Strangulation risk increases with time&raquo_space;> ischaemia.

· Bowel obstruction.