Fermol hernia

Description

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Your muscles are usually strong and tight enough to keep your intestines and organs in place, but a hernia can develop if there are any weak spots.

What is a femoral hernia

A femoral hernia is an uncommon type of hernia. Femoral hernias sometimes appear as a painful lump in the inner upper part of the thigh or groin. The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.
For information on other types of hernia, see:
• inguinal hernia
• hiatus hernia
• umbilical hernia

What causes a femoral hernia

A femoral hernia usually occurs when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh.
It pushes through a weak spot in the surrounding muscle wall (abdominal wall) into an area called the femoral canal.
Unlike inguinal hernias, femoral hernias occur far more frequently in women, particularly older women. This is because of the wider shape of the female pelvis. Femoral hernias are rare in children.
Femoral hernias can sometimes appear suddenly because of strain on the tummy, such as:
• straining on the toilet if you have constipation
• carrying and pushing heavy loads.
Straining can contribute to the weakening of the muscle walls. Factors that can lead to overstraining include:
• childbirth
• chronic constipation
• heavy lifting
• being overweight
• difficult urination due to an enlarged prostate
• chronic coughing
• giving birth
• having ascites or an abnormal buildup of abdominal fluid
• receiving dialysis, or treatment for kidney disease
They’ve also been linked to obesity and having a persistent, heavy cough.
Complications that can develop as a result of a femoral hernia include:
• obstruction – where a section of the bowel becomes stuck in the femoral canal, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin
• strangulation – where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply, so it doesn’t die.

Signs and symptoms of a femoral hernia

You may not even realize you have a femoral hernia in some cases. Small and moderate-sized hernias don’t usually cause any symptoms. In many cases, you may not even see the bulge of a small femoral hernia.
Large hernias may be more noticeable and can cause some discomfort. A bulge may be visible in the groin area near your upper thigh. 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.
• severe stomach pain
• sudden groin pain
• nausea
• vomiting

Diagnosis

Between 35 and 40 percent of femoral hernias do not receive a diagnosis until the person experiences hernia strangulation or bowel obstruction. Research suggests that there is a 10-fold increase in the risk of death in these acute cases.
A doctor will need to examine the bulge and confirm that it is a hernia before recommending repair. They will gently press on the area and may order imaging tests to see the internal tissues.

Ultrasound

Scanning below the inguinal ligament, assessing the space medial to the femoral vein for a hernia. The Valsalva maneuver can be performed to provoke herniation; the common femoral vein should also dilate 6.

CT

Femoral hernias typically have a characteristic funnel-shaped neck.
On axial CT images, the neck of the femoral hernia sac may be seen as a narrow protrusion through the femoral ring just medial to the common femoral vein. This can often look indented and compressed by the hernia sac.
Coronal images can also be very useful and it is usually seen in the space containing the fat pad between the inguinal ligament, common femoral vein and adductor longus muscle 5. Assessment of compression of the femoral vein and any distal engorgement should be made.

Differential diagnosis

The main differential is made with inguinal hernias. Femoral hernias are more common in women and unlike inguinal hernias, they remain lateral to the pubic tubercle. Femoral hernias invariably compress the femoral vein, while it is rare for an inguinal hernia to compress the femoral vein.

Risk factors

Though the direct cause may be unknown, some people are at higher risk than others.
Risk factors include:
• Sex: Both sexes can develop a femoral hernia, but they occur approximately 10 timesmore often in females. This is because the female pelvis is wider than the male pelvis.
• Age: Femoral hernias are far more common in adults than in children. If a child does develop one, it typically results from a medical condition, such as a connective tissue disorder.
• Family history: People with a close family member who has a groin hernia have up to 8 times the risk of developing one themselves.

Treatment

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Your muscles are usually strong and tight enough to keep your intestines and organs in place, but a hernia can develop if there are any weak spots.

What is a femoral hernia?

A femoral hernia is an uncommon type of hernia.

Femoral hernias sometimes appear as a painful lump in the inner upper part of the thigh or groin. The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.

For information on other types of hernia, see:

What causes a femoral hernia?

A femoral hernia usually occurs when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh.

It pushes through a weak spot in the surrounding muscle wall (abdominal wall) into an area called the femoral canal.

Unlike inguinal hernias, femoral hernias occur far more frequently in women, particularly older women. This is because of the wider shape of the female pelvis. Femoral hernias are rare in children.

Femoral hernias can sometimes appear suddenly because of strain on the tummy, such as:

  • straining on the toilet if you have constipation
  • carrying and pushing heavy loads.

Straining can contribute to the weakening of the muscle walls. Factors that can lead to overstraining include:

They’ve also been linked to obesity and having a persistent, heavy cough.

Complications that can develop as a result of a femoral hernia include:

  • obstruction – where a section of the bowel becomes stuck in the femoral canal, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin
  • strangulation – where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply, so it doesn’t die.

Signs and symptoms of a femoral hernia

You may not even realize you have a femoral hernia in some cases. Small and moderate-sized hernias don’t usually cause any symptoms. In many cases, you may not even see the bulge of a small femoral hernia.

Large hernias may be more noticeable and can cause some discomfort. A bulge may be visible in the groin area near your upper thigh. 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.

Diagnosis

Between 35 and 40 percent of femoral hernias do not receive a diagnosis until the person experiences hernia strangulation or bowel obstruction. Research suggests that there is a 10-fold increase in the risk of death in these acute cases.

A doctor will need to examine the bulge and confirm that it is a hernia before recommending repair. They will gently press on the area and may order imaging tests to see the internal tissues.

Ultrasound

Scanning below the inguinal ligament, assessing the space medial to the femoral vein for a hernia. The Valsalva maneuver can be performed to provoke herniation; the common femoral vein should also dilate 6.

CT

Femoral hernias typically have a characteristic funnel-shaped neck.

On axial CT images, the neck of the femoral hernia sac may be seen as a narrow protrusion through the femoral ring just medial to the common femoral vein. This can often look indented and compressed by the hernia sac.

Coronal images can also be very useful and it is usually seen in the space containing the fat pad between the inguinal ligament, common femoral vein and adductor longus muscle 5. Assessment of compression of the femoral vein and any distal engorgement should be made.

Differential diagnosis

The main differential is made with inguinal hernias. Femoral hernias are more common in women and unlike inguinal hernias, they remain lateral to the pubic tubercle. Femoral hernias invariably compress the femoral vein, while it is rare for an inguinal hernia to compress the femoral vein.

Risk factors

Though the direct cause may be unknown, some people are at higher risk than others.

Risk factors include:

  • Sex: Both sexes can develop a femoral hernia, but they occur approximately 10 timesmore often in females. This is because the female pelvis is wider than the male pelvis.
  • Age: Femoral hernias are far more common in adults than in children. If a child does develop one, it typically results from a medical condition, such as a connective tissue disorder.
  • Family history: People with a close family member who has a groin hernia have up to 8 times the risk of developing one themselves.

treatment

Surgical hernia repair

Femoral hernia repair is a procedure to fix the weak portion of the muscle wall. This intervention stops internal tissues from pushing through and causing a bulge. Moderate and severe hernias typically require surgery.

There are 2 types of surgery for femoral hernia repair. The type of surgery necessary depends on the size of the hernia, the person’s age, their general health, and other factors.

Laparoscopic

Doctors perform this minimally invasive surgery under general anesthesia. It involves making several small incisions in the lower abdomen.

The surgeon will then place a thin tube with a tiny camera, a laparoscope, into the incisions. They will also insert surgical tools into the other incisions to move the tissue back into the abdomen and repair the damaged muscle with mesh.

Laparoscopic surgery is not suitable for all patients, for example, those with a very large hernia.

Femoral hernia repair is a procedure to fix the weak portion of the muscle wall. This intervention stops internal tissues from pushing through and causing a bulge. Moderate and severe hernias typically require surgery.
There are 2 types of surgery for femoral hernia repair. The type of surgery necessary depends on the size of the hernia, the person’s age, their general health, and other factors.
Laparoscopic
Doctors perform this minimally invasive surgery under general anesthesia. It involves making several small incisions in the lower abdomen.
The surgeon will then place a thin tube with a tiny camera, a laparoscope, into the incisions. They will also insert surgical tools into the other incisions to move the tissue back into the abdomen and repair the damaged muscle with mesh.
Laparoscopic surgery is not suitable for all patients, for example, those with a very large hernia.

Leave a Reply

Your email address will not be published. Required fields are marked *