Femoral Hernia

Question 1

def

Answer 1

abnormal protrusion of a peritoneal sac, often with abdominal contents, through the femoral canal

Question 2

aetiology

Answer 2

personal anatomy of the femoral canal is the predisposing factor

Question 3

what are the boundaries of the femoral canal

Answer 3

anteriorly the inguinal ligament
medially the lacunar ligament
posteriorly the pectineal (cooper’s) ligament & pubic bone
laterally the femoral vein

Question 4

associations/risk factors

Answer 4

1 women
-wider angle between inguinal ligament + pectineal part of the pubic bone
-therefore a wider femoral canal
2 raised intra-abdominal pressure
-heavy lifting
-cough
-straining (constipation)

Question 5

epi

Answer 5

less common than inguinal hernias

female:male, 4:1

Question 6

history

Answer 6

can present as a lump/bulge in the groin
however often go unnoticed until they become strangulated or obstructed + present as an emergency (80%)
-abdo pain + distension
-nausea + vomiting

Question 7

why do femoral hernias become strangulated or obstructed

Answer 7

they have a tight neck

Question 8

examination

Answer 8

1 swelling in groin below + lateral to pubic tubercle
2 if strangulated, hernia may be tender
3 if obstructed, may have abdominal distension with tinkling bowel sounds

Question 9

what are the differential diagnoses for femoral hernia

Answer 9

inguinal hernia
lymphadenopathy
groin or psoas abscess

Question 10

investigations

Answer 10

1 bloods
-FBC, UEs, clotting
-ABG (for metabolic acidosis in bowel ischaemia)
2 imaging
-AXR may show bowel obstruction
-USS to exclude DDx

Question 11

management for emergency femoral hernia

Answer 11

• resuscitation with IV fluids + electrolytes
• NG tube if vomiting
• antibiotics with signs of sepsis

Question 12

what is the definitive treatment for femoral hernias

Answer 12

surgery

Question 13

management of femoral hernias with surgery

Answer 13

dissection of the sac, reducing the contents, repairing the defect
1 suturing the inguinal + pectineal ligaments
2 mesh within the femoral canal
3 open surgery
-low (lockwood) transverse incision over the hernia
-transinguinal (lotheissen) incision above + parallel to the inguinal ligament
-high (mcevedy) approach

Question 14

when is the high (mcevedy) approach used

Answer 14

when strangulation of the hernia is suspected

Question 15

complications

Answer 15

femoral hernias commonly strangulate
-bowel obstruction + ischaemia
-gangrene
surgery
-bleeding
-venous thrombosis
-infection

Question 16

why is there a risk of venous thrombosis

Answer 16

can occur with repair due to narrowing of the femoral vein

Question 17

prognosis

Answer 17

good with surgery

recurrence after repair is uncommon

Question 18

where does a direct inguinal hernia commonly occur

Answer 18

protrudes through hesselback triangle

passes medial to the inferior epigastric artery

Question 19

where does a indirect inguinal hernia commonly occur

Answer 19

protrudes through inguinal ring

passes lateral to the inferior epigastric artery

Question 20

where does a femoral hernia commonly occur

Answer 20

protrudes below the inguinal ligament

lateral to the pubic tubercle