What is a Femoral Hernia?

The hernia sac protruding through the femoral ring through the femoral canal to the oval fossa is called a femoral hernia. The incidence of femoral hernias accounts for about 3% to 5% of external abdominal hernias, and is more common in women over 40 years of age. The female pelvis is relatively wide, and the combined tendon and lacunar ligament are weak, so that the upper mouth of the femoral tube is wide and loose, so it is easy to get sick.

Basic Information

English name

femoral hernia

Visiting department

General surgery

Multiple groups

Women over 40

Common causes

Crotch ring relaxation and increased intra-abdominal pressure

Common symptoms

Hemispherical protrusion at oval fossa below inguinal ligament

Causes of femoral hernia

The female pelvis is wider, and the combined tendon and pit ligaments are often underdeveloped or thin, resulting in a wide and relaxed femoral ring, coupled with the incentive for increased intraabdominal pressure, which causes the falling abdominal viscera to enter the femoral canal through the femoral ring, protruding from the oval fossa. , So women are more common. The contents of the hernia are mostly the small intestine and the greater omentum. Since the femoral canal is almost vertically downward, the contents of the hernia seem to fall straight, but once the oval fossa emerges, it turns to the front and forms an acute angle, plus the loop itself It is narrow and the surrounding ligaments are tough, so it is prone to incarceration and strangulation. Pregnancy is the main cause of increased intra-abdominal pressure. Femoral hernias are caused by increased intraabdominal pressure and loosening of the thighs.

Femoral hernia clinical manifestations

Hernias are often small. It usually appears as a hemispherical protrusion at the oval fossa below the inguinal ligament. After receiving the contents in the supine position, the hernia mass sometimes does not completely disappear. This is because there is a lot of fat accumulation outside the hernia sac. Due to the narrow neck, the impact of cough is not obvious. Symptoms of recurrent femoral hernia are mild and often not noticed by patients, especially those who are obese are more likely to be negligent. Some patients may feel pain in the affected area when they are standing for a long time or coughing, and have a reducible mass.

If incarcerated femoral hernia occurs, in addition to causing local obvious pain, it is often accompanied by more obvious acute mechanical intestinal obstruction. In severe cases, it can even cover the local symptoms of femoral hernia. The hernia mass of the femoral hernia is usually not large, mainly manifested by a semi-spherical bulge at the oval fossa, usually the size of a walnut, and a soft texture that is reversible. Incarceration occurs in about half of the cases, causing significant local pain, and only when the acute intestinal obstruction hernia appears. Therefore, patients with acute intestinal obstruction, especially middle-aged women, should pay attention to check for femoral hernia to avoid missed diagnosis.

Femoral hernia

Clinical examination and necessary auxiliary examinations such as ultrasound examination.

Femoral hernia diagnosis

Diagnostic criteria:

(1) Hemispherical bulges below the groin can be easily overlooked, and the affected area may have tenderness.

(2) Finger-sized masses are touched at the oval fossa of the femur, and the mass disappears or becomes smaller after being supine. After the omentum is incarcerated to form adhesions, the compressed mass cannot be reduced or disappeared. The mass was tender when incarcerated, and it may have clinical manifestations of acute intestinal obstruction.

Six differential diagnosis

The diagnosis of a femoral hernia is sometimes not easy, and it should be specifically distinguished from:

Inguinal hernia

Inguinal hernias are located above and below the inguinal ligament, and femoral hernias are located below and below the inguinal ligament. It is generally not difficult to make a differential diagnosis. It should be noted that in addition to a part of the larger femoral hernia located below the inguinal ligament, a portion of the larger hernia may extend subcutaneously above the inguinal ligament. Using your fingers to detect whether the outer ring is enlarged can help distinguish between the two.

2. Lipoma

The femoral hernia often has a thickened layer of adipose tissue outside the hernia sac. After the hernia contents are absorbed, the local mass may not completely disappear. This adipose tissue may be misdiagnosed as a lipoma. The difference between the two is that the base of the lipoma is not fixed, the mobility is large, and the base of the femoral hernia is fixed and cannot be pushed.

3. Swollen lymph nodes

Incarcerated femoral hernia is often misdiagnosed as inguinal lymphadenitis.

4. Nodular swollen varicose veins

The nodular enlarged saphenous vein at the oval fossa enlarges when standing or coughing, and disappears when lying supine, which may be misdiagnosed as a recurrent femoral hernia. Compression of the proximal end of the femoral vein can increase the nodular enlargement. In addition, the presence of varicose veins in other parts of the lower limbs is important for differential diagnosis.

5. lumbosacral tuberculous abscess

A cold abscess caused by tuberculosis of the spine or sacroiliac joint can flow along the psoas muscle to the groin area and present as a mass. This lump can have a coughing impact, and it can temporarily shrink while lying down, which can be confused with a femoral hernia. Close inspection showed that this abscess was mostly located in the lateral popliteal fossa of the groin, and it felt fluctuating. Examination of the spine often reveals symptoms of the lumbar spine.

Femoral hernia treatment

The femoral hernia is easily incarcerated, and once incarcerated, it can quickly develop into strangulation. Therefore, after the diagnosis of femoral hernia is determined, it should be treated in time. For incarcerated or strangulated femoral hernias, emergency surgery is even more urgent.

The most commonly used surgery is McVay repair. This method can not only strengthen the posterior wall of the inguinal canal to repair the inguinal hernia, but also can be used to block the femoral ring and repair the femoral hernia. Another method is to close the femoral ring by stitching the inguinal ligament, the lacunar ligament, and the pubic fascia under the inguinal ligament after the hernia sac has been treated. Can also use tension-free hernia repair or laparoscopic hernia repair.

Incarcerated and strangulated femoral hernia surgery, because the hernia ring is small, it is often difficult to retrieve the contents of the hernia. In this case, the inguinal ligament can be severed to enlarge the thigh. However, after the hernia contents have been received, the severed ligament should be repaired carefully.

Femoral hernia prevention

Avoid factors that cause increased intra-abdominal pressure such as constipation. In extra-abdominal hernias, the prognosis of the femoral hernia is poor, mainly due to the ease of neglect of the diagnosis and the high strangulation rate. Once the femoral hernia occurs, it can easily develop into strangulation and endanger the life of the patient. Therefore, once the femoral hernia is diagnosed, surgery should be performed early to prevent incarceration.

1. The initial onset of hernia should be given enough attention and need to be properly and effectively maintained. As daily walking and activities form a habitual fall, once it is stuck at the ring mouth, it cannot be reset, which will cause intestinal necrosis.

2. Adhere to appropriate, appropriate and timely exercise to enhance physical fitness, improve disease resistance, do not do bouncing, limping, pulling, holding heavy and other violent activities.

3. Pay attention to diet conditioning. Eat warm, cooked and soft, avoid raw, cold and hard food. Eat less and eat more to prevent oversatisfaction. Choose foods that are nutritious and easy to digest and absorb. Reducing the burden on the stomach is also reducing the pressure on the hernia.

4. Preventing constipation and maintaining smooth stool are the key to preventing hernia. The elderly abdominal wall is weak, due to constipation, defecation, increased abdominal pressure, and promote hernia down, which is difficult to grasp the normal maintenance of hernia.