Femoral Hernia

What is a Hernia?

Hernia refers to a viscus growth on the body. The resultant protrusion of tissue, or even a part of the affected organ displays three distinct segments: the orifice, hernial sac, and contents. Hernias are commonly classified according to their location along the anatomy. The commonly observed hernias include abdominal hernias, diaphragmatic hernias, pelvic hernias, intracranial hernias and hernias of the nucleus pulposus. Hernias are characterized as congenital, complete or incomplete, internal or external or intraparietal, bilateral and incarcerated. If neglected, hernial contents develop complications such as strangulation, obstruction and organ dysfunction.

Femoral Hernia:

Femoral hernia develops along the femoral canal located just below the inguinal ligament. The femoral canal is defined by the inguinal ligament and normally contains negligible lymphatics and areolar tissue. Occasionally, this region is also characterized by the presence of Cloquet's node. The main function of the femoral canal is to expand when necessary, to accommodate the venous stress on the leg, during related activity. When this ligament is affected by a femoral hernia, the lateral aspect of the pubic tubercle weakens, further affecting the function of the intra-abdominal region.

The development of femoral hernia during pregnancy calls for a surgical emergency. If the opening or the mouth of the hernia is small, then the amount of tissue that is exposed is limited. However, in a contrasting case, the tissue could become incarcerated, diminishing blood supply to nearby organs and bone structures. This strangulation could lead to the development of gangrene and bacteria invasion. Femoral hernias around the female pelvis carry increased health risks if exposed to strenuous activity or even a chronic cough. Such a condition causes the hernia to enlarge and exposes the pregnant woman to the complications associated with a weakened abdominal muscle tone and obesity.

Signs and Symptoms:

Femoral hernias manifest in any one or a combination of the following symptoms:

• Painful or painless lump in the groin.
• Intestinal obstruction.

Diagnosis and Treatment Options:

A differential diagnosis pattern is followed to distinguish between an inguinal hernia, an enlarged lymph node, femoral artery aneurysm, saphena varix and a psoas abscess. The clinical diagnosis is carried out on the basis of findings from ultrasonography, MRI or CT scans. X-rays of the abdominal cavity are are also taken to identify the region and actual cause for bowel obstruction. Femoral Hernias develop very near the leg crease and develop to merge with the inguinal ligament, lower pubic bone and femoral vein. This makes diagnosis a real challenge. Since the groin gap is more in females due to the natural pelvis shape and angle, femoral hernias are commonly observed more in females. Like other hernias, the treatment plan for femoral hernia develops around operative intervention. Surgery or herniorrhaphy is performed under general anesthesia, and usually varies between the following three methods:

• Lockwood infra-inguinal
• Lotheissen trans-inguinal
• McEvedy high

While the infra-inguinal method helps a lot in elective reconstruction, the trans-inguinal approach dissects the inguinal canal, weakening the region even more. The McEvedy treatment option for femoral hernia is usually adopted when organ strangulation is suspected. It is very important for the surgeon to access and visualize bowel dysfunction, to avoid urinary bladder injury, since the organ lies adjacent to the hernia. Surgery methods for femoral hernia repair involves suturing the inguinal ligament to the pectineal ligament or insertion of a mesh plug within the femoral ring.