Download position of femoral hernia

Femoral Hernia
OBJECTIVES
By the end of this lecture students should be able to:
 Describe hernia and femoral hernia
 Describe the femoral canal and its anatomy
 Know the types of femoral hernia
 Know the complications of a femoral hernia
 Describe the risk factors for femoral hernia
 Diagnose and know the management of the femoral hernia
HERNIA

A hernia is a protrusion of any viscus from its proper
cavity

The protruded parts are generally contained in a saclike structure, formed by the membrane with which
the cavity is naturally lined
FEMORAL HERNIA

A femoral hernia is a protrusion of a loop of the
intestine through a weakened abdominal wall, located
in the lower abdomen near the thigh

Occur just below the inguinal ligament, through the
femoral canal.
POSITION OF FEMORAL HERNIA
DEFECT (femoral canal):
 It is in an anatomic triangular-shaped "gap",
located between the following 3 structures:



The inguinal ligament
The lower side of the pubic bone
The femoral vein
FEMORAL CANAL
LOCATION:
 Located below the inguinal ligament on the lateral aspect of the
pubic tubercle, within the Femoral triangle
BOUDARIES:
 Anteriorly by inguinal ligament
 Posteriorly by pectineal ligament
 Medially by lacunar ligament
 Laterally by femoral vein.
CONTENTS:
 A few lymphatics, loose areolar tissue and a
Cloquet's node.
FUNCTION:
 Allows the femoral vein to expand to
accommodate increased venous return from the leg during periods
of activity.
GENERAL INFORMATION





Relatively uncommon (only 3% of all hernias).
Almost all develop in women because of the wider
pelvis.
More common in adults.
In children more likely to be associated with a
connective tissue disorder or with conditions that
increase intra-abdominal pressure.
70% of pediatric cases occur in infants under the
age of one
TYPES OF FEMORAL HERNIA


Reducible
Irreducible
Or




Simple
Incarcerated
Strangulated
Obstructed
1. Reducible hernia: Occurs when a femoral hernia can be
pushed back into the abdomen, either spontaneously or with
manipulation.


Most common type
usually painless.
2. Irreducible hernia: Occurs when a femoral hernia becomes
stuck(incarecerated) in the femoral canal.
 This can cause pain and a feeling of illness
1. SIMPLE: uncomplicated, reducible hernia
2. INCARCERATED: The trapping of abdominal
contents within the Hernia itself.
 The causes an irreducible hernia.
 The risk of injury to abdominal contents and
intestine is increased.
3. STRANGULATED: Injury to the blood circulation to the
intestine caused by incarceration.
 The Intestine will become necrotic and gangrenous if not
corrected early.
 This is an absolute medical emergency
4. OBSTRUCTED: This occurs when a part of the intestine becomes
intertwined with the hernia, causing an intestinal obstruction.
laproscopic view of incarcerated hernia
PRESENTATION OF FEMORAL HERNIA
SYMPTOMS:
 They typically present when standing erect as a groin
lump or bulge
 They may or may not be associated with pain
SIGNS:
 A lump in the groin.
 No cough impulse
 Reducible/irreducible
 The bulk of a femoral hernia lies below an imaginary line
drawn between the anterior superior iliac spine and the
pubic tubercle
RISK FACTORS FOR FEMORAL HERNIA
Risk Factors for Hernias in general include:
 Family history of hernias
 Overweight or Obesity
 Undescended testes in an infant male
 Any condition that increases the abdominal pressure: e.g.,
 chronic coughing,
 chronic constipation
 enlarged prostate causing straining with urination,
 carrying or pushing heavy loads
DIAGNOSIS AND MANAGEMENT
Diagnosis:
 Clinical largely done by physical examination of the groin.
 ultrasonography, CT or MRI may aid in the diagnosis.
Management:
 Surgery (as an urgent elective procedure )
LEARNING RESOURCES









http://www.emedicinehealth.com
http://emedicine.medscape.com
http://www.nlm.nih.gov/
North Penn Hernia Institute
http://hernia.tripod.com
http://www.searchmedica.co.uk
http://myweb.lsbu.ac.uk
http://www.surgical-tutor.org.uk
www.mejfm.com/volume-5_issue-8 (Middle East Journal of Family
Medicine)