Femoral Hernia / Hernia in Thigh
Femoral Hernia
Femoral hernias occur
just below the inguinal
ligament, when abdominal contents pass through a naturally occurring
weakness called the femoral
canal.
.
Femoral herniae are more common in females than in males.
Femoral Hernia
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Coverings Of A Femoral Hernia
When a femoral hernia descends, the intestine pushes in front of it the peritoneum,
septum crurale (subperitoneal tissue), and the femoral sheath (transversalis
fascia) and makes its appearance at the saphenous opening. The
cribriform fascia closing the saphenous opening gives it a covering, and
also the subcutaneous tissue and skin above.
Causes of Femoral Hernia:-
·
Metabolic, Storage Disorders
o
Obesity, massive
o
Obesity
·
Deficiency Disorders
o
Malnutrition/Starvation
·
Anatomic, Foreign Body, Structural Disorders
·
Functional, Physiologic Variant Disorders
o
Coughing, vigorous/effects
o
Heavy lifting
o
Weight lifting activity
o
Weight loss
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 small bowel obstruction.
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 anterior superior
iliac spine and the 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.
The diagnosis is largely a clinical one, generally done by physical
examination of the groin. However, in obese patients, 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.
Several other conditions have a similar presentation and must be
considered when forming the diagnosis: inguinal hernia, an enlarged
inguinal lymph node, aneurysm of the femoral artery, saphena varix, and
an abscess of the psoas.
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Management of Femoral
Hernias:-
Absolutely surgery is always advised for femoral hernias as there is
hardly any truss that can support femoral hernias and chances of
strangulation in femoral hernias are very high.The strangulation of
femoral hernias carry a high degree of morbidity.
Femoral hernias, like most other hernias, usually need operative
intervention. This should ideally be done as an elective (non-emergency)
procedure. However, because of the high incidence of complications,
femoral hernias often need emergency surgery.
Surgery may be performed under general or regional anaesthesia. Three
approaches have been described.
-
Lockwood’s infra-inguinal approach
-
Lotheissen‘s trans-inguinal approach
·
McEvedy’s high approach
Mesh
plug placed into femoral canal.