Femoral hernia overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
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.
Femoral hernias occur just below the inguinal ligament, when abdominal contents pass through a naturally occurring weakness called the femoral canal.
Historical Perspective
Hernia means a protrusion, hernias have been present in humans since the beginning of time, and the first interventions can be dated as early as the fifteenth century in ancient Egypt. However interventions had always been reserved for very large protrusions or painful incarcerated hernias.
Classification
Femoral hernia may be occasionally classified into several subtypes based on anatomical relation.
Pathophysiology
A femoral hernia is the protrusion of the hernia sac through the femoral ring in to the femoral canal. The anatomy of the femoral canal is such that the neck is made up of rigid structures that predispose herniated bowel to strangulation and incarceration. The hernia sac contains small bowel which can predispose to intestinal obstruction. Some connective tissue diseases predispose the patient to developing femoral hernia. Malignancy is very rarely associated with femoral hernias, thus histopathological analysis is done routinely following a repair but shows incarcerated bowel on most occasions.
Causes
The most common cause of femoral hernia is an enlarged femoral ring. Less common causes of femoral hernia include increased intra-abdominal pressure and pregnancy.
Differentiating Femoral hernia overview from other diseases
Femoral hernia must be differentiated from other diseases that cause swelling in the groin area, such as inguinal hernia, femoral artery aneurysm, saphenous vein varicosity, lymphadenopathy and lipoma.
Epidemiology and Demographics
The prevalence of femoral hernia is estimated to be 2% - 8% of all groin hernias. The incidence of femoral hernia increases with age, individuals commonly affected are between 40 -70 years of age. Females are more commonly affected than males.
Risk Factors
Common risk factors in the development of femoral hernia include female gender, increasing age and a history of recurrent hernias.
Screening
There is insufficient evidence to recommend routine screening for femoral hernia.
Natural History, Complications, and Prognosis
If left untreated, 44%-86% of patients with femoral hernia may progress to develop strangulation or incarceration.
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References