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1

Femoral Hernia

* PATHOLOGY

* CLINICAL PICTURE:

* Differential Diagnosis

* Investigations

* TREATMENT

2

PATHOLOGY of Femoral Hernia

* Defect

* Sac

* Contents

* Coverings

3

Defect in PATHOLOGY of Femoral Hernia

Femoral ring.

4

Sac in PATHOLOGY of Femoral Hernia

* The pathway

* The reason it doesn't continue inferiorly

* The neck

5

The pathway Sac in PATHOLOGY of Femoral Hernia

The sac of the femoral hernia pass

* downwards in the femoral canal

then

* forwards stretching the cribriform fascia of the saphenous opening

then

* upwards and laterally towards anterior superior iliac spine taking its retort shape.

6

The reason it doesn't continue inferiorly in Sac in PATHOLOGY of Femoral Hernia

* Wrong answer but said in lectures

* Right answer

7

Wrong answer but said in lectures in The reason it doesn't continue inferiorly in Sac in PATHOLOGY of Femoral Hernia

Due to attachment of scarpas fascia to lower border of saphenous opening

8

Right answer of The reason it doesn't continue inferiorly in Sac in PATHOLOGY of Femoral Hernia

because of the strong attachment & fusion
of the deep and superficial fascia of the thigh below the saphenous opening.

9

The neck in Sac in PATHOLOGY of Femoral Hernia

* The neck of the sac is narrow

* so femoral hernia is more liable to irreducibility and strangulation

10

Contents in PATHOLOGY of Femoral Hernia

* Omentum

* Intestine

* Only a part of the circumference of the intestine
(Richter's hernia).

11

Coverings in PATHOLOGY of Femoral Hernia

1. Skin.

2. Subcutaneous fat & Scarpa's fascia.

3. Stretched cribriform fascia.

4. Anterior layer of the femoral sheath:

12

CLINICAL PICTURE of Femoral Hernia

* Symptoms

* Examination

13

Symptoms in CLINICAL PICTURE of Femoral Hernia

* Painless swelling in upper part of thigh ( femoral triangle)

* Females are Commonly affected

14

The reason why Females are Commonly affected in Symptoms in CLINICAL PICTURE of Femoral Hernia

1. Repeated pregnancy )> inc. abdominal pressure

2. Small sized femoral vein )> Wide femoral ring

3. wider pelvis

15

Examination in CLINICAL PICTURE of Femoral Hernia

A swelling with the following criteria

* Site

* Size

* Shape

* Edge

* Surface

* Consistency

* Special character

* Descent

* Reduction

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Site of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

Femoral triangle.

17

Size of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

Variable.

18

Shape of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

Early rounded & then retort

19

Edge of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

Well defined.

20

Surface of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

Usually smooth

21

Consistency of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

Soft or doughy

22

Special character of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

* may give Expansile impulse on cough unless complicated

* Usually irreducible

23

Descent of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

Downwards, forwards and then upwards and laterally.

24

Reduction of the swelling in Examination in CLINICAL PICTURE of Femoral Hernia

Usually irreducible but early it can be reduced
backward and upward.

25

Differential Diagnosis of Femoral Hernia

1- Inguinal hernia.

2- Swellings of the femoral triangle

26

Inguinal hernia in Differential Diagnosis of Femoral Hernia

Inguinal hernia is above and medial to the pubic tubercle.

Femoral hernia is below and lateral to the pubic tubercle.

27

Swellings of the femoral triangle in Differential Diagnosis of Femoral Hernia

A. Reducible femoral hernia

B. Irreducible femoral hernia

28

Reducible femoral hernia in Swellings of the femoral triangle in Differential Diagnosis of Femoral Hernia

* Saphena varix.

* Femoral artery aneurysm.

* Varicose aneurysm "A-V fistula".

* Psoas abscess.

29

Irreducible femoral hernia in Swellings of the femoral triangle in Differential Diagnosis of Femoral Hernia

* Lipoma.

* Ectopic testis

* Inguinal lymph node.

* Psoas bursa.

30

Investigations of Femoral Hernia

As inguinal hernia.

1) Investigations to detect underlying cause of increased abdominal pressure:

2) Routine preoperative investigations