Coupon Accepted Successfully!


Femoral Hernia

  1. Epidemiology
    1. Accounts for 5% (5-10%)of Groin Hernias (96% are inguinal)
    2. More common in elderly women (F: M = 3:1). 
  2. Anatomy:
    Femoral canal - 1.25 cm long from the femoral ring above to the saphenous opening below.
  3. Pathophysiology
    1. Associated with increased intra-abdominal pressure
    2. Hernia sac bulges into femoral canal, which is continuation of femoral sheath
    3. Femoral canal lies immediately medial to femoral vein  
  4. Mechanism:
    1. Hernia is narrow in the canal
    2. No resistance at the saphenous opening - expands upwards towards abdomen, because the deep fascia of the abdomen is attached lower to the saphenous opening to the fascia lata.
    3. May form inverted retort shape - may traverse above Ing. lig.
    4. Predisposes to strangulation d.t. tortuous course, narrow canal, fixed rigid ring. 
  5. Symptoms and Signs
    1. Groin Pain and tenderness often absent, strangulation occurs often without pain Q
    2. Hernia sac neck location palpable lateral and inferior to pubic tubercle
    3. Large femoral hernias may bulge over inguinal ligament  
  6. Differential Diagnosis
    1. Inguinal Hernia, Inguinal Lymphadenopathy, Varix of Saphenous Vein (Thrill on palpation; Fills on standing and empties while supine).
    2. Infectious Bubo (Chancroid, Syphilis, Lymphogranuloma venereum)  
  7. Varieties :
    1. Laugier's Femoral hernia - Occurs through a defect in the lacunar ligament (of Gimbernat). A small hernia in a very medial position. Almost always presents as strangulated.
    2. Narath's femoral hernia - Seen in Congenital dislocation of hip. Occurs due to lat displacement of the psoas. Q
    3. Cloquet's femoral hernia - Occurs behind the pectineus muscle. The hernia is behind the femoral vessels.
    4. Pre-vascular femoral hernia - Occurs in front of the inguinal ligament and the femoral vessels. Has a wide neck and less tendency to strangulate.
  8. Treatment : No role for conservative management e.g. truss
    Operations : the hernia is reduced, & repair done by stitching the conjoint tendon to the Cooper's ligament.
  1. Low Approach ( LOCKWOOD)
    Groin crease incision/ high risk of injury to abnormal obturator Artery/ not used in strangulation as intestine not well approached.
  2. High Approach ( McEVEDY)
    Vertical incision over femoral canal extended over the ing. lig. up to the abdomen/ Good control over abnormal obturator Artery/ Useful in strangulated hernias/ higher risk of incisional hernia.  
  3. Inguinal Approach ( LOTHEISSEN ) Q
    Incision over inguinal canal/ Good control over abnormal A.

Test Your Skills Now!
Take a Quiz now
Reviewer Name