Femoral hernias occur just below the inguinal ligament.
With a femoral hernia the abdominal contents pass through a naturally occurring weakness in the abdominal wall called the femoral canal.
Femoral hernias are more common in multiparous females.
Femoral hernias result from elevated intra-abdominal pressure that dilates the femoral vein and in turn stretches femoral ring.
Intra-abdominal pressure causes preperitoneal fat to insinuate in the femoral ring, a consequence of which is development of a femoral peritoneal sac.
The femoral canal is located below the inguinal ligament on the lateral aspect of the pubic tubercle.
The femoral canal is bounded by the inguinal ligament anteriorly, pectineal ligament posteriorly, lacunar ligament medially, and the femoral vein laterally.
It occasionally a lymph node called Cloquet’s node.
The function of this canal appears to be to allow the femoral vein to expand when necessary to accommodate increased venous return from the leg during periods of activity.
Femoral hernias accounting for only 3% of all hernias.
Almost all femoral hernias develop in women due to the increased width of the female pelvis.
Femoral hernias typically present as a groin lump or bulge.
Femoral hernias may differ in size during the day, based on internal pressure variations of the intestine.
The bulge or lump is typically smaller or may disappear completely in the prone position.
Femoral hernias may be associated with pain.
Often, femoral hernias 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, and are often found to be the cause of unexplained small bowel obstruction.
The femoral hernia bulge is more globular than the pear-shaped lump of the inguinal hernia.
They are more common in adults than in children.
Femoral hernias that occur in children are likely to be associated with a connective tissue disorder or with conditions that increase intra-abdominal pressure.
Seventy percent of pediatric cases of femoral hernias occur in infants under the age of one.
A femoral hernia may be either reducible or irreducible, obstructed and/or strangulated.
A reducible femoral hernia occurs when a femoral hernia can be pushed back into the abdominal cavity, either spontaneously or with manipulation.
Reducible femoral hernia is the most common type of femoral hernia and is usually painless.
An irreducible femoral hernia occurs when a femoral hernia cannot be completely reduced.
Irreducible hernias are typically due to adhesions between the hernia and the hernial sac.
Irreducible hernias can cause pain,
A femoral hernia that is obstructed occurs when a part of the intestine involved in the hernia becomes twisted, kinked, or constricted, resulting in an intestinal obstruction.
A strangulated femoral hernia occurs when a constriction of the hernia limits or completely obstructs blood supply to part of the bowel involved in the hernia.
While strangulation can occur in all hernias, it is more common in femoral and inguinal hernias due to their narrow areas of abnormality in the abdominal wall.
Nausea, vomiting, and severe abdominal pain are characteristic of a strangulated hernia, and is a medical/surgical emergency.
Loss of blood supply to the bowel can result in necrosis followed by gangrene.
An incarcerated hernia is a hernia that cannot be reduced, and may lead to bowel obstruction but are not associated with vascular compromise.
A hernia is reducible if the contents within the sac can be pushed back through the defect into the peritoneal cavity.
An incarcerated hernia is stuck in the hernia sac.
The diagnosis is largely a clinical one
On obese patients, imaging in the form of ultrasound, CT, or MRI may aid in the diagnosis.
Differential diagnosis: inguinal hernia, an enlarged femoral lymph node, aneurysm of the femoral artery, dilation of the saphenous vein, and an abscess of the psoas.
There are a number of types of femoral hernias depending on its location relative to the femoral artery.
Such hernias usually need operative intervention.
Because they are associated with a high incidence of complications, femoral hernias often need emergency surgery.
Either open or minimally invasive surgery may be performed under general or regional anesthesia,
The surgery performed depends on the extent of the intervention needed.
Three approaches have been described for open surgery:
Lockwood’s infra-inguinal approach
Lotheissen‘s trans-inguinal approach
McEvedy’s high approach
For elective repair the infra-inguinal approach is the pref2242ed.