Diagnosis

Femoral hernia

Etiology

Etiology/Epidemiology [afq]

1. Physical activity --> increased intra-abdominal pressure

2. The femoral canal: a congenital weakness in the abdominal wall

3. Increasing age/muscular atrophy --> Widening or weakness of the femoral ring

4. Herniation of the abdominal viscera (usually contain small bowel or omentum)

Classification

• Reducible hernia: The protruding viscus can be returned to the abdomen

• Irreducible (incarcerated) hernia: The protruding viscus cannot be returned

• Strangulated hernia: The vascularity of the viscus is compromised

Risk Factors [afq]

• Advanced age

• Obesity

• Smoking

• Pregnancy

• Connective tissue disorders

Complications [afq]

• Incarceration

• Bowel strangulation

• Fecal contamination

Epidemiology

Incidence per 100.000 [7q1][n7i][gum]

Approach

• Physical exam (diagnosis is usually clinical)

• Blood test

• Blood gas

• Ultrasound abdomen

• CT abdomen

Treatment

1. Watchful waiting [qsv]: 

   • Asymptomatically or minimally symptomatic

   • Do not wish to undergo elective hernia repair

2. Surgery: [qsv]

   • Bowel obstruction

   • Signs of strangulation (painful groin mass, fever, tachycardia, hypotension, emesis)

   • Open repair with mesh (Lichtenstein tension-free) technique

   • TransAbdominal Preperitoneal (TAP) approach

   • Totally ExtraPeritoneal approach (TEP)

Differential diagnoses

Adhesion, Colorectal cancer, Diverticulitis, Femoral artery aneurysm, Gastrointestinal obstruction, Hematoma, Hydrocele, Inguinal hernia, Lipoma, Lymphadenopathy, Psoas abscess, Varices, Varicocele, Volvulus