Femoral hernia is relatively uncommon but are an important problem due to their high rate of strangulation (because of their narrow neck). Femoral hernia occurs when abdominal viscera or omentum passes through the femoral ring and into the potential space of the femoral canal.
Femoral hernias account for 5% of abdominal hernias and are more common in women than men (ratio 3:1), because of the wider anatomy of the female bony pelvis. It is very rare for a femoral herniation to occur in a child.
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The exact cause of femoral and other hernias are unknown most of the time. You may be born with a weakened area of the femoral canal, or the area may become weak over time.
Straining can contribute to the weakening of the muscle walls. Factors that can lead to overstraining include:
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Large hernias may be more noticeable and can cause some discomfort. The most apparent symptom is a lump on the upper inner thigh or groin. The lump may be tender or painful. It sometimes may seem to disappear when a person is lying down and may worsen when they are straining. The pain may not just be in the area of the hernia; it can radiate to your hip, back and leg.
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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 symptoms can signify that a femoral hernia is obstructing your intestines. This is a very serious condition called strangulation. Strangulation causes intestinal or bowel tissue to die, which can put your life in danger. This is considered a medical emergency. Severe symptoms of a femoral hernia include:
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In adults, femoral hernias that enlarge, cause symptoms, or become incarcerated are treated surgically. Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient. The two main types of surgery for hernias are as follows:
In open hernia repair, also called herniorrhaphy, a person is given local anesthesia in the abdomen or spine to numb the area, general anesthesia, or a combination of the two. The surgeon makes an incision in the groin, moves the hernia back into the abdomen. Repair is either performed by suturing the inguinal ligament to the pectineal ligament using strong non-absorbable sutures or by placing a mesh plug in the femoral ring.
Laparoscopic surgery is a minimally invasive procedure performed using general anesthesia. The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope-a thin tube with a tiny video camera attached to one end. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh.
People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine laparoscopic surgery is not the best option if the hernia is very large or the person has had pelvic surgery.
Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are restricted for several weeks. The doctor will discuss when a person may safely return to work. Infants and children also experience some discomfort but usually resume normal activities after several days.
A femoral hernia can cause serious medical problems if left untreated, even if there are no troublesome symptoms to begin with. These complications may include:
Incarcerated hernia: A hernia can grow to obstruct the bowel if its contents become trapped in the weak area of the abdominal wall. An obstructed bowel will result in nausea, vomiting, an inability to pass gas or have a bowel movement, and severe pain.
Strangulation: An incarcerated hernia may block the flow of blood to part of your intestine. That strangulation can result in the death of the affected bowel tissue. A strangulated hernia requires immediate surgery; it is life threatening.
A femoral hernia will not heal by itself and does require surgery to be repaired. All femoral hernias need to be treated surgically as they have a high risk of becoming strangulated. A femoral hernia repair is routinely performed as a day case, without the need for an overnight stay in hospital. The type of anesthesia will depend on the exact operation and the preferences of the surgeon and patient. Femoral hernia repairs are routinely carried out under general or regional anesthesia (where just the area being treated is anesthetized).
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