Femoral Hernia

Question 1

What is a femoral hernia

Answer 1

Most common in women
Occurs through tissues of the femoral canal
High risk of strangulation because the neck of the sac is surrounded by bony and ligament out structure on three sides, limiting it

30% of them are emergencies - 50% of them require bowel resection because of strangulation and ischemia

Question 2

Clinical presentation

Answer 2

Appears lateral and below to the pubic tubercle and medial to femoral pulse

May be mistaken for an upper, medial thigh swelling

Typically causes a flattening and fold of the skin crease (this distinguishes it from inguinal hernias)

Question 3

Diagnosis

Answer 3

By clinical presentation

Differential diagnosis

• low presenting inguinal hernia
• femoral canal lipoma
• femoral lymph node
• saphena varix (dilation of the saphenous vein)- disappears when lying down and has an audible thrill when per cussing the saphenous vein
• femoral artery aneurysm (pulsating)

USG may help diagnosis
If there is significant doubt- exploration is usually indicated due to high risk of complications in untreated femoral hernias

Question 4

Treatment

Answer 4

• once the hernia is reduced, the femoral canal should be narrowed by interrupted sutures to prevent recurrence
• care must be taken not to narrow the adjacent femoral vein
• 2 main approaches
  1. low approach: incision below inguinal ligament approaching the femoral canal from below. Advantage of not interfering with the inguinal structures but provides little/no scope for respecting any compromised bowel. Usually for elective surgery

2. high approach: incision above inguinal ligament approaching the femoral canal from above by dissecting through the posterior wall of the inguinal canal. Requires repair of the inguinal canal on closure but offers excellent access to the peritoneal cavity in case small bowel surgery is needed. Usually for emergency surgery