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It was my Viva question and I was really puzzled.I know what is femoral hernia and it route like the abdominal content moves down the femoral canal and further through the saphenous opening and all but I have no idea about it's coverings.Can anyone please help me
Femoral hernia coverings (from inside out):
- Femoral septum (extraperitoneal fatty, connective and lymphoid tissue)
- Tranversalis fascia
- Cribriform fascia
- Superficial fascia
Image source: SurgWiki, Creative Commons Licence
How to tell if you have a femoral hernia
A femoral hernia occurs when tissue pushes through a weak spot in the muscle wall of the groin or inner thigh. Common causes include being overweight and overstraining while coughing, exercising, or passing stool.
Symptoms of a femoral hernia include a lump in the groin or inner thigh and groin discomfort. It may cause stomach pain and vomiting in severe cases.
Femoral hernias are uncommon, accounting for fewer than 5 percent of all groin hernias. Typically, surgical repair is necessary because femoral hernias can lead to severe complications.
In this article, we discuss the causes and symptoms of a femoral hernia, how to get a diagnosis, when to see a doctor, and potential treatment options.
Share on Pinterest Moving heavy objects and being obese may cause femoral hernias.
A femoral hernia results from internal tissues pushing through a weak point in the muscle wall, near the groin or inner thigh.
The exact cause may be unknown. Sometimes, people may be born with a structurally weak muscle wall in the area.
Femoral hernias can also result from straining or excess pressure in the area due to:
- passing urine or stool
- being obese
- lifting or pushing heavy objects
- having a persistent, strong cough
- giving birth
- having ascites or an abnormal buildup of abdominal fluid
- receiving dialysis, or treatment for kidney disease
Though the direct cause may be unknown, some people are at higher risk than others.
- Sex: Both sexes can develop a femoral hernia, but they occur approximately 10 times more often in females. This is because the female pelvis is wider than the male pelvis.
- Age: Femoral hernias are far more common in adults than in children. If a child does develop one, it typically results from a medical condition, such as a connective tissue disorder.
- Family history: People with a close family member who has a groin hernia have up to 8 times the risk of developing one themselves.
The most apparent symptom is a lump on the upper inner thigh or groin. The lump may be tender or painful. It sometimes may seem to disappear when a person is lying down and may worsen when they are straining.
According to research from the North American Journal of Medical Sciences , approximately 60 percent of femoral hernias occur on the right-hand side of the body and 30 percent on the left-hand side. The remaining 10 percent affect both sides.
Aside from a small bulge, most femoral hernias do not cause symptoms. However, severe cases may cause:
People who suspect they have a femoral hernia should see their doctor promptly. This is because there is a high risk of complications that can be serious.
Between 35 and 40 percent of femoral hernias do not receive a diagnosis until the person experiences hernia strangulation or bowel obstruction. Research suggests that there is a 10-fold increase in the risk of death in these acute cases.
A doctor will need to examine the bulge and confirm that it is a hernia before recommending repair. They will gently press on the area and may order imaging tests to see the internal tissues.
Small hernias that do not cause symptoms may not require surgery. Doctors may monitor them regularly instead to check for progression of symptoms and the potential for complications.
If a femoral hernia becomes trapped, obstructed, or strangulated, it can cause additional symptoms and complications. A strangulated hernia is a life-threatening situation that requires immediate medical attention.
Incarcerated femoral hernia
This occurs when a hernia becomes trapped in the femoral canal, and it cannot move back into the abdomen.
Obstructed femoral hernia
When a hernia and a section of the intestine become entangled, doctors call it an obstructed hernia. It can lead to a painful intestinal obstruction.
Strangulated femoral hernia
This complication arises when a hernia prevents blood from reaching the bowel. It is a medical emergency that can be fatal without treatment.
Symptoms of this complication include:
- sudden, worsening pain and extreme tenderness around a hernia
- rapid heart rate
- skin redness around the bulge
Without immediate surgery, a strangulated femoral hernia can cause the intestinal tissue to die and decay. This can result in life-threatening infection, and so immediate treatment is necessary.
Femoral hernia repair is a procedure to fix the weak portion of the muscle wall. This intervention stops internal tissues from pushing through and causing a bulge. Moderate and severe hernias typically require surgery.
There are 2 types of surgery for femoral hernia repair. The type of surgery necessary depends on the size of the hernia, the person’s age, their general health, and other factors.
Surgical hernia repair may be:
People having open surgery typically receive general anesthesia, meaning they are fully asleep for the operation. They may sometimes receive a local anesthetic so that the area is numb, but they are awake for the procedure.
The surgeon will begin by making a small incision in the groin to access the hernia. They will move the bulging tissue back into the abdomen before repairing the femoral canal wall with strong stitches or a piece of mesh.
Doctors perform this minimally invasive surgery under general anesthesia. It involves making several small incisions in the lower abdomen.
The surgeon will then place a thin tube with a tiny camera, a laparoscope, into the incisions. They will also insert surgical tools into the other incisions to move the tissue back into the abdomen and repair the damaged muscle with mesh.
Laparoscopic surgery is not suitable for all patients, for example, those with a very large hernia.
Recovery time is, however, usually quicker than open surgery. There is also less scarring than with an open repair.
Femoral Hernia vs. Other Hernias
A femoral hernia occurs in the upper part of the thigh or groin when a part of your small intestine or other abdominal contents pushes into the femoral canal. The femoral canal is a naturally occurring structure between the femoral vessels and the pubic bone. Femoral hernias differ from other types of hernias (inguinal, umbilical, etc.) because of the location at which they occur. They can be caused by improper lifting techniques, acute trauma, childbirth, chronic coughing, and other factors.
The symptoms of a femoral hernia can include any of the following:
- Pain in the upper thigh or groin area
- Nausea and vomiting
- A bulge near your upper thigh or groin
Femoral hernias can range greatly in size bur are usually fairly small. With small femoral hernias, a patient may not even notice any symptoms. On the other end of the spectrum, incarcerated or trapped femoral hernias can impact the intestines and cut off blood flow. These hernias require emergency surgery.
Lifetime occurrence of a groin hernia is 27% to 43% in men and 3% to 6% in women.ꃾmoral hernias occur less commonly than inguinal hernias and typically account for about 3% of all groin hernias. While inguinal hernias are still most common, regardless of gender, femoral hernias have a female-to-male ratio of about 10:1. Femoral hernias are rare in men. There may be other co-existing defects present at the time of diagnosis, as 10% of women and 50% of men with a femoral hernia either have or will develop an inguinal hernia. The prevalence of a femoral hernia increases with age as does the risk of complications including incarceration or strangulation.
Both femoral and inguinal hernias occur more often on the right side. This is likely due to a developmental delay in closure of the processus vaginalis after the normal slower descent of the right testis during fetal development. There is agreement that the position of the sigmoid colon results in a tamponade effect on the left femoral canal, decreasing the likelihood of a left-sided defect.
All the above-mentioned hernias may take time to show their symptoms. Sometimes, these hernias do not show any symptoms and remain at the site for prolonged periods. Once the symptoms show up it may impact your quality of life to a greater extent. Therefore, it’s essential to diagnose such problems at an early stage in order to avoid complications during surgery.
A research paper with the title, "Hernias as a Cause of Chronic Pelvic Pain in Women" published in the Journal of the Society of Laparoscopic and Robotic Surgeons, explained that the indirect inguinal hernia is the most common type of hernia that develops in women. These tend to be present since birth. Another most common hernia in women is the femoral hernia.
The anatomy of the men makes them susceptible to developing a hernia. There is a small hole around the groins through which blood vessels pass and connect with the testicles. With age, the muscles around this area weaken and the gaps widen. Hence, muscles or organs can push through this opening and result in inguinal hernia.
Primarily, all the various types of hernia surgery can be categorized into the following three-
A femoral hernia is usually diagnosed during a physical examination . In many cases, the patient will
In adult patients, the doctor will rule out the possibility that the pain is caused by an enlarged lymph node, a lipoma, or an inguinal hernia. Imaging studies are not generally used in diagnosing a hernia unless the doctor suspects that the hernia is incarcerated or strangulated. A strangulated hernia can be distinguished from an incarcerated hernia by the presence of fever pain that persists after the doctor has reduced the hernia manually and pain that is more severe than warranted by the examination findings.
If the doctor suspects that the hernia is strangulated, he or she will give the patient a broad-spectrum antibiotic (usually cefoxitin) intravenously before the patient is taken to the operating room .
Adults scheduled for a nonemergency herniorraphy are given standard blood tests and a urinalysis . They should not eat breakfast on the morning of the procedure, and they should wear loose-fitting, comfortable clothing that they can easily pull on after the surgery without straining their abdomen.
Diagnosis for Femoral Hernia
If you face any of the above symptoms, it is very important that you consult your doctor at the earliest. The doctor will examine the area carefully by touching it gently in order to conclude if you have femoral hernia or not. After this, an ultrasound of the area is performed in order to confirm the diagnosis.
What happens during femoral hernia repair surgery?
A variety of anaesthetic techniques are possible. The operation usually takes less than an hour. Your surgeon will make an incision (cut) in your groin and remove the "hernial sac". They will strengthen the muscle layer with stitches and will usually insert a synthetic mesh to cover the weak spot.
Sometimes this operation is done using minimally invasive laparoscopic (key hole) surgery. You should discuss which method will be used with your surgeon.
Going home after femoral hernia repair
Recovery from hernia repair is usually very quick. You will probably go home the day of the surgery. You will be mobile very soon after the procedure and will be encouraged to increase how much you walk around over the first few days post surgery. Many patients return to normal day to day activities within the first week.
You should not do any heavy lifting or strenuous activity for one month. Please discuss your return to work with your surgeon prior to discharge from the hospital. Occasionally the hernia comes back.
What complications can happen?
Every surgical procedure has a risk of complications. Be sure and discuss any concerns you might have about these risks with your surgeon.
General complications of any operation:
- Infection in a surgical wound
- Blood clots
- Unsightly scarring
Specific complications of femoral hernia repair surgery:
- Developing a lump under the wound
- Difficulty passing urine
- Injury or narrowing of the femoral vein
- Injury to structures within the hernia
- Temporary weakness of the leg
- Injury to nerves
Why not print this treatment page so you can discuss any concerns you have with your surgeon?
Treatments Femoral Hernias
There is a risk of all hernias causing a blockage if not repaired. Surgery is the only method of fixing a femoral hernia. A procedure to repair a femoral hernia can be performed using an &ldquoopen&rdquo method, in which a surgeon makes an incision in your groin area, pushes the hernia back inside the abdomen, and places a piece of mesh to strengthen the abdominal wall. When possible, Mount Sinai surgeons are also able to perform this procedure using a laparoscopic method, which involves making small cuts through which a small camera and surgical instruments are inserted to repair the hernia.
A total of 180 consecutive femoral hernia repairs, consisting of 100 emergency and 80 elective admissions between January 1979 and December 1986, were reviewed. Morbidity was greater in the emergency than in the elective group (P <0·01) and was significantly related to intestinal obstruction (P <0·001), a feature not previously highlighted. Intestinal obstruction also had an important association with mortality, which was confined to patients undergoing emergency surgery. Patients with intestinal obstruction are a high-risk group and require careful perioperative management. Wound infection predisposed to recurrence of femoral hernia (P <0·01). Repair of recurrent hernia in patients treated electively was associated with an increased incidence of chest infection (P <0·001). Prophylactic measures, including antibiotics, may help to reduce recurrence and its associated morbidity. Patients referred with an inguinal lump or hernia, as opposed to a femoral hernia, had a later outpatient appointment and consequently a later operation date (P <0·02). All elderly patients referred with any groin lump should receive an early outpatient appointment.
- hernia, femoral
- intestinal obstruction
- perioperative care
- wound infections
- lower respiratory tract infections
- older adult
- inguinal mass
- emergency surgical procedure