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| {{Femoral hernia}} | | {{Femoral hernia}} |
| {{CMG}} | | {{CMG}} |
| ==Overview==
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| A [[hernia]] is caused by the protrusion of a viscus (in the case of groin hernias, an intraabdominal organ) through a weakness in the containing wall. This weakness may be inherent, as in the case of inguinal, femoral and umbilical hernias. On the other hand, the weakness may be caused by surgical incision through the muscles of the abdominal/thoracic wall. Hernias occurring through these are called incisional hernias.
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| '''Femoral hernias''' occur just below the [[inguinal ligament]], when abdominal contents pass through a naturally occurring weakness called the [[femoral canal]].
| | ==[[Femoral hernia overview|Overview]]== |
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| ==Anatomy== | | ==[[Femoral hernia historical perspective|Historical Perspective]]== |
| The [[femoral canal]] is located below the inguinal ligament on the lateral aspect of the [[pubic tubercle]] (note: inguinal hernias are above and medial to the pubic tubercle; femoral are below and lateral). It is bounded by the [[inguinal ligament]] anteriorly, [[pectineal ligament]] posteriorly, [[lacunar ligament]] medially, and the [[femoral vein]] laterally. It normally contains a few lymphatics, loose areolar tissue and occasionally a lymph node called Cloquet's node. The function of this canal appears to be to allow the femoral vein to expand when necessary to accommodate increased venous return from the leg during periods of activity.
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| ==Clinical Features== | | ==[[Femoral hernia pathophysiology|Pathophysiology]]== |
| ===Symptoms===
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| Femoral hernias are more common in women, usually elderly and frail (although they can happen in children). They typically present as a groin lump. They may or may not be associated with pain. Often, they present with a varying degree of complication ranging from irreducibility through intestinal obstruction to frank gangrene of contained bowel. The incidence of strangulation in femoral hernias is high. A femoral hernia has often been found to be the cause of unexplained [[Intestinal obstruction|small bowel obstruction]]. | |
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| ===Signs=== | | ==[[Femoral hernia causes|Causes]]== |
| The obvious finding may be a lump in the groin. Cough impulse is often absent and should not be relied on solely when making a diagnosis of femoral hernia. The lump is more globular than the pear shaped lump of the inguinal hernia. The bulk of a femoral hernia lies below an imaginary line drawn between the [[Ilium (bone)|anterior superior iliac spine]] and the [[Ilium (bone)|pubic tubercle]] (which essentially represents the [[inguinal ligament]]) whereas an inguinal hernia starts above this line. Nonetheless, it is often impossible to distinguish the two preoperatively.
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| ===Differential Diagnoses=== | | ==[[Femoral hernia differential diagnosis|Differentiating Femoral hernia from other Diseases]]== |
| * [[Inguinal hernia]]
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| * Enlarged inguinal [[lymph node]]
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| * [[aneurysm|Aneurysm]] of the femoral artery
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| * Saphena Varix
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| * Psoas abscess
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| ==Management== | | ==[[Femoral hernia epidemiology and demographics|Epidemiology and Demographics]]== |
| Femoral hernias like most other hernias need operative intervention. This should ideally be done as an elective procedure. However, because of the high incidence of complications femoral hernias often need emergency surgery.
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| ===Investigations=== | | ==[[Femoral hernia risk factors|Risk Factors]]== |
| The diagnosis is largely a clinical one. However, in the difficult (obese) patient imaging in the form of ultrasonography, CT or MRI may aid in the diagnosis. An abdominal x-ray showing small bowel obstruction in a female patient with a painful groin lump needs no further investigation.
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| ===Surgery=== | | ==[[Femoral hernia screening|Screening]]== |
| Surgery may be performed under general or regional anaesthesia. Three approaches have been described.
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| * Lockwood’s infra-inguinal approach
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| * Lotheissen‘s trans-inguinal approach
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| * McEvedy’s high approach
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| The infra-inguinal approach is the preferred method for elective repair. The trans-inguinal approach involves dissecting through the inguinal canal and carries the risk of weakening the inguinal canal. McEvedy’s approach is preferred in the emergency setting when strangulation is suspected. This allows better access to and visualisation of bowel for possible resection. In any approach care should be taken to avoid injury to the urinary bladder which is often a part of the medial part of the hernial sac.
| | ==[[Femoral hernia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Repair is either performed by suturing the [[inguinal ligament]] to the [[pectineal ligament]] using strong non-absorbable sutures or by placing a mesh plug in the femoral ring. With either technique care should be taken to avoid any pressure on the [[femoral vein]].
| | ==Diagnosis== |
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| ===Postoperative Outcome===
| | [[Femoral hernia history and symptoms|History and Symptoms]] | [[Femoral hernia physical examination|Physical Examination]] | [[Femoral hernia laboratory findings|Laboratory Findings]] | [[Femoral hernia x ray|X Ray]] | [[Femoral hernia CT|CT]] | [[Femoral hernia MRI|MRI]] | [[Femoral hernia ultrasound|Ultrasound]] | [[Femoral hernia other diagnostic studies|Other Diagnostic Studies]] |
| Patients undergoing elective repair do very well and may be able to go home the same day. However, emergency repair carries a greater morbidity and mortality rate and this is directly proportional to the degree of bowel compromise. Patient's other co-existing medical conditions also influence outcome.
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| ==External links== | | ==Treatment== |
| *[http://www.surgeryencyclopedia.com/Ce-Fi/Femoral-Hernia-Repair.html Surgery Encyclopaedia]
| | [[Femoral hernia medical therapy|Medical Therapy]] | [[Femoral hernia surgery|Surgery]] | [[Femoral hernia primary prevention|Primary Prevention]] | [[Femoral hernia secondary prevention|Secondary Prevention]] | [[Femoral hernia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Femoral hernia future or investigational therapies|Future or Investigational Therapies]] |
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| ==External links== | | ==Case Studies== |
| *[http://www.hernia.org/ Hernia Resources]
| | [[Femoral hernia case study one|Case #1]] |
| *[http://www.herniablog.com/ The Hernia Blog]
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| *[http://www.herniasymptoms.org/ Hernia Symptoms]
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| *[http://www.wikisurgery.com/index.php?title=Hernia-femoral-adult-Operationscript Hernia femoral adult: Operation Script on Wikisurgery].
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| *[http://www.wikisurgery.com/index.php?title=Hernia-femoral-adult-daycase-Patientinformation Hernia femoral adult day case: Information for patients on Wikisurgery].
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| {{Gastroenterology}}
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| [[Category:Hernias]] | | [[Category:Hernias]] |