FEMORAL HERNIA

Definition

Femoral hernia is the protrusion of abdominal contents through the femoral canal, below the inguinal ligament.

Basic Anatomy of Femoral Canal

• Femoral canal is the medial compartment of the femoral sheath
• Length: about 1–2 cm
• Extends from femoral ring to saphenous opening
• Contents:
  • Lymphatics
  • Cloquet’s lymph node
  • Loose areolar tissue
• Boundaries:
  • Anterior: Inguinal ligament
  • Posterior: Pectineal ligament and pectineus muscle
  • Medial: Lacunar ligament
  • Lateral: Femoral vein

Types of Femoral Hernia

• Femoral hernia (no true direct or indirect classification clinically)
• Classified practically as:
  • Reducible
  • Irreducible
  • Obstructed
  • Strangulated

Causes

• Increased intra-abdominal pressure
  • Chronic cough
  • Constipation
  • Heavy lifting
  • Obesity
• Weak abdominal wall
• Multiparity
• Pregnancy
• Old age
• Female pelvis (wider femoral canal)

Clinical Features

• Small swelling below and lateral to pubic tubercle
• More common in elderly females
• Groin pain or discomfort
• Swelling increases on standing and coughing
• Cough impulse often absent
• Frequently presents as strangulated hernia
• Features of intestinal obstruction in complicated cases

Investigations

• Clinical examination
• Ultrasound of groin
• CT scan abdomen and pelvis (best investigation)
• X-ray abdomen if intestinal obstruction suspected

Complications

• Incarceration
• Intestinal obstruction
• Strangulation
• Necrosis of bowel
• Perforation and peritonitis

Management

• Surgery is mandatory in all femoral hernias
• No role of conservative treatment
• Emergency surgery in strangulated hernia

Surgical Treatment

• Herniotomy with herniorrhaphy
• Mesh repair preferred

Surgical Approaches

• Low approach (Lockwood)
• Trans-inguinal approach (Lotheissen)
• High approach (McEvedy) – preferred in strangulation

Basic Surgical Steps

1 → Incision over femoral region
2 → Exposure of femoral canal
3 → Identification and isolation of hernia sac
4 → Reduction of contents
5 → Ligation and excision of sac
6 → Closure of femoral canal with sutures or mesh

Blood Supply

• Femoral artery
• Inferior epigastric artery
• Deep circumflex iliac artery

Nerve Supply

• Femoral nerve
• Ilioinguinal nerve
• Iliohypogastric nerve

Clinical Anatomy Importance

• Lies below inguinal ligament
• Medial to femoral vein
• Narrow neck → high risk of strangulation

Homoeopathic Therapeutics

• Arnica montana: pain and bruising
• Calcarea carbonica: weakness and poor tissue strength
• Nux vomica: strain-related complaints
• Lachesis: inflammatory swelling
• Hypericum: nerve pain

Key Points

• Common in elderly females
• High risk of strangulation
• Always requires surgical repair
• Early diagnosis prevents complications