Emergency Presentation and Management of a Hernia By Ketan Vagholkar [CC BY 3.0], via Int. [teachmesurgery.com]

The present case is a 40-year-old lady who presented with a painless lump in the right groin and was diagnosed as a case of hydrocoele of a femoral hernia sac only after exploration. [ncbi.nlm.nih.gov]

• Inguinal Pain

  CONCLUSIONS: Chronic postoperative pain is as important a complication after femoral hernia surgery as it is after inguinal hernia surgery. In contrast to inguinal hernia surgery, no risk factor related to surgical technique was found. [ncbi.nlm.nih.gov]

• Cough

  Physical examination revealed bilateral groin swellings with positive cough impulses, located below and lateral to the pubic tubercles, consistent with femoral hernias. [doi.org]

  (palpable cough impulse ) or a Valsalva maneuver Occasionally, the swelling is reducible. [amboss.com]

  Long-term coughing - Coughing places a strain on the abdominal wall. Long-term constipation. Complications Generally, hernias are more of an annoyance than a danger, but it is important to get it checked out. [sportsinjuryclinic.net]

  Swelling in the groin (below and lateral to the pubic tubercle) Impulse on coughing, reducibility and dragging pain Obstruction or strangulation – Painful, tender and inflamed Irreducible No cough impulse Vomiting 8. [slideshare.net]

  The hernia often appears or swells on coughing or straining and reduces in size or disappears when relaxed or supine. There may be a cough impulse. It may be possible to reduce the hernia. [patient.info]

• Chronic Cough

  Abdominal wall hernias are well recognised in patients with a chronic cough and respiratory disorders, and presumably this was the precipitating factor in this case. [doi.org]

  Some factors that contribute to the development of a hernia include: Chronic constipation Chronic cough Heavy lifting Obesity Straining to urinate because of an enlarged prostate Femoral hernias tend to occur more often in women than in men. [pinkwhalehealthcare.com]

  Indirect Inguinal Hernia. b) Acquired: Conditions which raise the intra-abdominal pressure e.g: chronic cough, straining at motions in chronic constipation, straining at micturition in enlarged prostate or stricture urethra and person who is heavy weight [web.archive.org]

• Vomiting

  A 91-year-old woman had a 6-day history of nausea and vomiting. She was referred to surgery because of persisting vomiting, but without any abdominal pain. A CT scan showed a hernia in the right groin area but the diagnosis was delayed. [ncbi.nlm.nih.gov]

• Nausea

  A 65-year-old woman presented with a nonradiating, constant pain in the right groin with associated nausea and anorexia. Physical examination revealed a tender, irreducible lump in the right groin area. [ncbi.nlm.nih.gov]

• Constipation

  If you do not have surgery right away: Increase your fiber intake and drink fluids to avoid constipation. Lose weight if you are overweight. See your provider if you have trouble urinating (men). Use proper lifting techniques. [nlm.nih.gov]

  In case that the intestine is trapped in hernia the patient may complain about constipation. [ic.steadyhealth.com]

  Following high-fibre diet with lots of fruit, vegetables and fluids can help to reduce the risk of constipation. Six weeks is the usual recovery period for femoral hernia surgery. [parkside-hospital.co.uk]

• Absent Bowel Sounds

  Symptoms Bulge or mass in groin Discomfort Dragging sensation Signs Bulge or mass in groin Cough impulse Reducible or irreducible Intestinal obstruction Nausea and vomiting Abdominal pain Abdominal distentions Absent bowel sounds Complete constipation [web.archive.org]

• Hip Pain

  The bulging may become worse and can cause pain when you stand up, lift heavy objects, or strain in any way. Femoral hernias are often located very close to the hip bone and as a result may cause hip pain. [healthline.com]

  The bulging may become worse and can cause pain when you stand up, lift heavy objects, or strain in any way. Hip pain can also be a symptom of a femoral hernia due to its location. [drmatthewlublin.com]

• Irritability

  They do not in themselves cause severe pain, but a complicated hernia or a hernia with a torn muscle or irritated nerve can cause pain. A complicated hernia is one which is stuck and the contents could be dying and surgery is more urgent of course. [geoffreydraper.com.au]

  In young kids, the signs of an incarcerated femoral hernia consist of serious irritability, abdominal pain, cramping, and vomiting. Adult patients might have also felt full of within the groin which may be tender when it's pressed. [laparoscopyhospital.com]

  This repair is usually reinforced with by a mesh made of a synthetic material that does not irritate the body. Laparoscopic surgery, which is also known as “keyhole” or “minimally invasive” surgery, may also be used. [scottishhernia.com]

  In young children, symptoms of an incarcerated femoral hernia include severe irritability, abdominal pain, cramping, and vomiting. Adult patients may have also felt a mass in the groin that may be tender when it is pressed. [surgeryencyclopedia.com]

  Testis at operation in 2-month-old boy with history of irritability and vomiting for 36 hours. Capsulotomy was performed, but atrophy occurred. Patient also required bowel resection. [emedicine.com]

• Seizure

  These include infants who have lung problems, seizure disorders, or heart diseases from birth or those who were born prematurely. [northshore.org]

  It is also higher in patients with ongoing increased intra-abdominal pressure, growth failure and malnutrition, prematurity, seizure disorder, or chronic respiratory problems. [emedicine.com]

• Urinary Retention

  Urinary retention in one patient and wound infections in two patients were treated within 2 weeks postoperatively. [ncbi.nlm.nih.gov]

  Common complications include nausea, vomiting, urinary retention, sore throat, and headache. More serious problems include heart attack, stroke, pneumonia, and blood clots in the legs. [gi.surgery.ucsf.edu]

Acute appendicitis and incarcerated femoral hernia belong to relatively well known surgical diseases with regard to diagnostic workup and treatment. de Garengeot's hernia is an entity involving concurrent occurrence of both the above mentioned problems [ncbi.nlm.nih.gov]

Diagnosis Laboratory studies include the following: Stain or culture of nodal tissue Complete blood count (CBC) Electrolytes, blood urea nitrogen (BUN), and creatinine Urinalysis Lactate Imaging studies are not required in the normal workup of a hernia [emedicine.com]

The classic treatment is through an open anterior approach. [ncbi.nlm.nih.gov]

Treatment depends on the symptoms present with the hernia. If you feel sudden pain in your groin, a piece of intestine may be stuck in the hernia. This is called an incarcerated hernia. This problem needs treatment right away in an emergency room. [nlm.nih.gov]

De Garengeot's hernia, through combination of two separate surgical entities, is associated with diagnostic difficulties and the therapeutic process occasionally requires unconventional decisions to be taken to improve prognosis. [ncbi.nlm.nih.gov]

Outlook (Prognosis) The chances of a femoral hernia coming back after surgery are low. If the intestine or other tissue becomes stuck, a portion of the intestine may need to be removed. [ufhealth.org]

Prognosis The mortality for elective hernia repair, both inguinal and femoral, is low - even at higher age. [patient.info]

The surgical technique is simple and feasible, while fully acknowledging the functional anatomy of the inguinofemoral region and the etiology of the condition. [ncbi.nlm.nih.gov]

Etiology In contrast to indirect inguinal hernias, which may occur congenitally, femoral hernias are almost always acquired. [amboss.com]

(Etiology) Having both, a weakened spot in the groin (femoral canal) and repeated or chronic strain (high intra-abdominal pressure) to the weakened area causes Femoral Hernia. [dovemed.com]

Synonym: rupture (2) See: illustration ; herniotomy hernial hernioid, adjective Etiology Hernias may be caused by congenital defects in the formation of body structures, defects in collagen synthesis and repair, trauma, or surgery. [medical-dictionary.thefreedictionary.com]

Etiology The etiology of indirect hernias is largely explainable in terms of the embryology of the groin and of testicular descent. An indirect inguinal hernia is a congenital hernia, regardless of the patient’s age. [emedicine.com]

Links: anatomy epidemiology aetiology clinical features differential diagnosis treatment returning to work after femoral hernia repair [gpnotebook.co.uk]

Epidemiology Epidemiological data refers to the US, unless otherwise specified. Etiology In contrast to indirect inguinal hernias, which may occur congenitally, femoral hernias are almost always acquired. [amboss.com]

This study aimed to outline the epidemiology of the procedures for repairing unilateral inguinal and femoral hernia in the Veneto Region, and to analyze the time trends and organizational appropriateness of these procedures. [ncbi.nlm.nih.gov]

Br J Surg 85: 1986–1691 Google Scholar Rutkow IM (1998) Epidemiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s. [link.springer.com]

[…] ring Allows expansion of the femoral vein Femoral ring Aperture behind medial portion of inguinal ligment Boundaries medial – lacunar ligament (safe to divide) lateral – fascia overlying femoral vein anterior – inguinal ligament posterior – pectineus Epidemiology [busyspr.com]

References: [3] Pathophysiology Boundaries of the femoral canal Typical femoral hernia : (common): protrusion of intraperitoneal contents along with the transverse abdominal fascia through the femoral ring into the femoral canal Atypical femoral hernias [amboss.com]

Aetiology & pathophysiology The two most important factors for the development of a hernia is inherent or acquired weakness and increased pressure. Inguinal hernias are more likely to occur at areas with an inherent or acquired weakness. [web.archive.org]

Pathophysiology Inguinal hernia The pinchcock action of the internal ring musculature during abdominal muscular straining prohibits protrusion of the intestine into a patent processus. Muscle paralysis or injury can disable the shutter effect. [emedicine.com]

Although exceedingly rare, the surgeon needs to be aware of this entity to prevent a delay in diagnosis with potentially serious adverse events. [ncbi.nlm.nih.gov]

The problem with this is that the blood supply to the hernia can become blocked which prevents it from receiving vital nutrients. [medic8.com]