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Femoral Hernia

Hernia Crural


Presentation

  • 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]
  • This is the first case combining two very rare pathologies--acute appendicitis presenting as strangulated femoral hernia and villous adenoma of the appendix.[ncbi.nlm.nih.gov]
  • Surgeons should be aware of the existence of this kind of atypical presentation of appendicitis.[ncbi.nlm.nih.gov]
  • A rare complication is being presented--a femoral hernia containing a strangulated Meckel's diverticulum. This is known as Littre's hernia, which often exhibits subtle variations from the norm in its presentation.[ncbi.nlm.nih.gov]
Inguinal Pain
  • METHODS: The Inguinal Pain Questionnaire was sent to 1967 patients who had had a repair for primary unilateral femoral hernia between January 1, 1997 and December 31, 2006. A follow-up period of at least 18 months was chosen.[ncbi.nlm.nih.gov]
Anorexia
  • 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]
Lymphadenopathy
  • […] groin – originates inferior to inguinal ligament but often clinically diffivult to differentiate from inguinal hernia when irreducible Cough impulse is commonly absent Differential diagnosis Inguinal hernia Psoas abscess or bursa Saphena varix Lipoma Lymphadenopathy[busyspr.com]
Respiratory Insufficiency
  • Past history included cystic fibrosis that had resulted in recurrent chest sepsis and chronic respiratory insufficiency.[doi.org]
Respiratory Disorders
  • 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]
Periumbilical Pain
  • Abstract The case of a 21-year-old man presenting with constant periumbilical pain is reported. The patient had a left groin mass which on palpation exacerbated his pain.[ncbi.nlm.nih.gov]
Persistent 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. The hernias were repaired using a preperitoneal transinguinal approach.[ncbi.nlm.nih.gov]
Thrombosis
  • Further investigation into the effect of the opposition technique on femoral vein compression and deep venous thrombosis is warranted.[ncbi.nlm.nih.gov]
  • Blood clots in the legs - clots in the calf (deep vein thrombosis / DVT) can usually be treated with medication, but a DVT can (rarely) move to the lungs. This can cause breathing difficulty, or even be life threatening.[surgerywise.com]
  • Other rarely encountered problems include excessive bleeding, infection or developing a blood clot within the leg veins (deep vein thrombosis). To help prevent this, most people are given compression stockings to wear during the operation.[scottishhernia.com]
  • Thrombosis and lung embolism. With the use calf compressors during surgery and advising early mobilization, these are rare complications. Bowel Trauma if it was trapped in the sac of a hernia, especially if it is a recurrent hernia.[web.archive.org]
Confusion
  • This report presents the case of a 73-year-old woman who was admitted with sepsis, cachexia and confusion secondary to a strangulated femoral hernia containing both the appendix (De Garengeot hernia) and a Meckel's diverticulum (Littre's hernia).[ncbi.nlm.nih.gov]
  • It accounts for less than 1% of all groin hernias in children and is often confused with inguinal hernia or other inguinal pathologies. Preoperative misdiagnosis has been reported to be between 40 and 75%.[ncbi.nlm.nih.gov]
  • Question and answer: Can a femoral hernia be confused with other conditions? Yes – it can be confused with an inguinal hernia. It can be found together with an inguinal hernia also.[hernia.net.au]
  • […] of all hernias and 6% of all groin hernias, the other 94% are inguinal), more likely to occur in women than in men (70% of femoral hernias occur in women, probably because of their wider pelvis making the femoral canal slightly larger) and are often confused[hernia.org]

Workup

  • 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]
  • A remarkable reduction in morbimortality can be achieved through an earlier referral to the hospital, quick preoperative workup, and urgent operation. Copyright 2013 Elsevier Inc. All rights reserved.[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]
Synovial Cyst
  • The patient underwent ultrasound examination which showed synovial cyst originating from the right hip. This is a rare presentation of hip synovial cyst and we have therefore decided to publish this case report.[ncbi.nlm.nih.gov]

Treatment

  • The classic treatment is through an open anterior approach.[ncbi.nlm.nih.gov]
  • Early surgical treatment is the only option to handle the problem.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: We found that preperitoneal repair is the method of choice in surgical treatment of femoral hernia.[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]
  • The combination of gangrenous appendicitis and strangulated loop of small bowel in a femoral hernial sac is an unusual finding, but awareness of it will avoid delay in treatment and lead to the patient's full recovery.[ncbi.nlm.nih.gov]

Prognosis

  • 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 prognosis depends on the type and size of hernia, as well as on the ability to reduce risk factors associated with the development of hernias.[emedicine.com]

Etiology

  • 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]
  • 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]

Epidemiology

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

Pathophysiology

  • 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]

Prevention

  • 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]
  • We believe that it is important to take into consideration herniation of the uterus and ovaries with omentum or small bowel into the femoral canal to prevent various complications related to the reproductive functions of the patient.[ncbi.nlm.nih.gov]
  • Inclusion of this entity in the differential diagnosis of groin masses, an accurate preoperative physical exam, and a careful surgical exploration will allow one to make the correct diagnosis and prevent unnecessary reoperations.[ncbi.nlm.nih.gov]
  • The Kugel patch repair method is available for all inguinal region hernias by the same approach, and it seems to be useful for preventing the development of recurrence after surgery.[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]

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