How does a femoral hernia work?
The femoral canal passes under the inguinal ligament, through which blood vessels and nerves normally pass to the leg. With weakness of the connective tissue and increased pressure in the abdomen, part of the peritoneum with its contents is pressed into this narrow space. Outside, a protrusion appears below the inguinal fold, closer to the inner surface of the thigh. Due to the rigid walls of the canal, the hernial orifice hardly stretches, so even a small section of the intestine or omentum is quickly compressed. In this way, a femoral hernia is fundamentally different from an inguinal hernia, which is located above the ligament.
- Bulging below the inguinal fold
- The gate is narrow and does not stretch
- Contents: omentum or loop of intestine
- The inguinal hernia is located above the ligament
- Most often unilateral, on the right
Symptoms
At an early stage, the hernia may not manifest itself at all or may be felt as slight discomfort in the upper thigh during exercise. Then a soft, round protrusion appears, the size of a cherry to a plum, which increases with straining, coughing and standing and decreases with lying down. There may be nagging pain radiating to the leg and discomfort when walking. Due to its small size, a femoral hernia is often mistaken for an enlarged lymph node or lipoma for a long time, and in obese people it is invisible until it is strangulated.
- Bulging below the inguinal fold
- Increases while standing and straining
- Decreases or disappears while lying down
- Nagging pain radiating to the leg
- Discomfort when walking and exercising
- Often goes unnoticed for a long time
Why is infringement dangerous?
When strangulated, the contents of the hernia are compressed in the narrow gate, and its blood supply is disrupted. The protrusion becomes dense, sharply painful and ceases to be reduced. If a loop of intestine is strangulated, intestinal obstruction quickly develops: cramping pain, vomiting appears, and the passage of gas and stool stops. Without surgery, after a few hours the area of the intestine becomes dead and peritonitis develops. With a femoral localization, the risk of strangulation is higher than with other hernias, so it is strictly forbidden to reduce it yourself.
- The protrusion is hard and cannot be reduced
- Sharp pain in the hernia area
- Vomiting and bloating
- Stopping the passage of gases
- Intestinal necrosis after a few hours
- Do not try to force a hernia back
Diagnostics
Usually the diagnosis is made by a surgeon during examination in a standing and lying position with a test for straining and coughing. Since the femoral hernia is small, it must be distinguished from enlarged inguinal lymph nodes, lipoma, varicose veins at the mouth of the great saphenous vein, and inguinal hernia. Ultrasound of the soft tissues of the groin area helps to clarify, which shows the hernial contents and its movement when straining. In difficult cases and with severe excess weight, CT is used. Before a planned operation, a standard set of tests is prescribed.
- Examination by a surgeon standing and lying down
- Test with straining and coughing
- Ultrasound of soft tissues of the groin area
- Abdominal ultrasound
- CT scan with a questionable picture
- Preoperative tests
Treatment
A femoral hernia does not go away on its own and is not treated with bandages and exercises: the only method is surgery. Due to the high risk of strangulation, it is recommended to perform it as planned, without waiting for complications. During the intervention, the hernial sac is isolated, the contents are returned to the abdominal cavity, and the femoral canal is closed with its own tissue or a mesh implant. The operation is possible through open and laparoscopic access. In case of strangulation, surgery is performed urgently, and if a section of the intestine is not viable, it has to be removed, so postponing planned treatment is unprofitable.
- Elective surgery - the main method
- Closing the canal with mesh or your own tissues
- Open or laparoscopic approach
- Bandages and exercises do not eliminate hernia
- In case of strangulation - emergency surgery
- After surgery, restriction of exercise for several weeks
