Femoral Hernia Flashcards
Femoral hernias are quite uncommon.
Why are they important to know about?
High rate of strangulation due to their narrow neck
When does femoral hernia occur?
When abdominal viscera or omentum passes through the femoral ring and into the potential space of the femoral canal.
Epidemiology
5% of abdo hernias
M 1:3 F
This is due to wider anatomy of the female pelvis
Explain femoral canal anatomy
Located in the anterior thigh.
The rigidity of the borders especially the lacunar ligament means that femoral hernias are prone to complications and strangulation.
Borders of femoral canal
Superior = femoral ring
Medial = lacunar ligament
Anterior = inguinal ligament
Posterior = pectineus
Lateral = femoral vein
Risk factors
Female
Pregnancy
Raised intra-abdominal pressure
Increasing age
Clinical features
Small lump in the groin
Usually asymptomatic
30% of femoral hernias will present as an emergency by obstruction or strangulation of the hernia.
How does the location differ of femoral hernias compared to inguinal.
Femoral = infero-lateral to the pubic tubercle and medial to femoral pulse.
Inguinal = supero-medial to the pubic tubercle.
Although a femoral hernia can rull up superior and in front of the inguinal ligament which means that they are often misdiagnosed as inguinal
Dx
Inguinal hernia
Femoral canal lipoma
LN
Saphena varix
Femoral artery aneurysm
Athletic pubalgia
Investigations
All patients with femoral hernia will need surgical intervention.
This means that even though the diagnosis is made clinically imaging is often required to plan pre-op.
USS can demonstrate a femoral hernia but is very operator dependent.
CT abdo-pelvis scan will show it and can debunk dxs.
If there is still doubt it should be surgically explored
Management of femoral hernias.
Surgically within 2 weeks of presentation due to the high risk of strangulation.
Approaches of surgical internvetion
Low approach
High approach
Explain low approach
Incision is made below the inguinal ligament
This means that there is less risk of damaging inguinal structures.
The hernia is then reduced and the femoral ring is narrowed with sutures or with a mesh plug.
Disadvantage of low approach
Limited space for removal of compromised small bowel
Explain high approach
Incision is made above the inguinal ligament.
The preferred technique in emergency intervention.
The hernia is then reduced and femoral ring is narrowed
