A hernia in the groin area that is above the inguinal ligament is an inguinal hernia. Extends at least half way over the superior pubic ramus compressing the femoral vein in the cross sectional view. When intestine or abdominal tissue fills the hernia sac and cannot be pushed back, it is called irreducible or incarcerated. I think it is best to first look at the basic anatomy of the inguinal canal to aid the understanding of the clinical findings and then move on to the principles of management.
Ligate and divide veins running into the sapheno femoral junction. Lockwoods infrainguinal, lotheissens transinguinal and mcevedys high approach. An overview of common hernias inguinal and femoral including the anatomy of the inguinal canal, causes of hernias and management options for hernias. The illusive femoral hernia is out of the ordinary. Rectus abdominus rectus abdominus arises from the pubic symphysis and pubic crest, and inserts into the xiphoid process and costal cartilages. Abd wall hernias university of tennessee college of medicine. In this article, the authors describe the anatomy of the inguinal region from the surgeons point of view, the causes and predisposing factors for inguinal hernia development, the diagnostic. The most common location is at the site of a femoral hernia. A femoral hernia that gets stuck or incarcerated, on the way to strangulation, can cause severe local and abdominal pain, nausea and vomiting. Feb 17, 2016 the risk of strangulation in a femoral hernia is 22% at 3 months and 45% at 21 months. Femoral hernias protrude inferior to the course of the inferior epigastric vessels and medial to the common femoral vein, often have a narrow funnelshaped neck, and may compress the femoral vein, causing engorgement of distal collateral veins. Minor diameter of right femoral vein a is less than two thirds of diameter of. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
The medical records of 38 patients who underwent femoral hernia repair between march 2006 and november 2011 were retrospectively analyzed. Laparoscopic anatomy of inguinal hernia diagnosis and management. The lifetime risk of having an inguinal or femoral hernia repair has been estimated to 27% for men and 3% for women. Clinical anatomy of the anterior abdominal wall in its relation to hernia. In this article, we shall look at the anatomy of the inguinal canal its development, borders and contents. Groin is the area between abdomen and the upper thigh on either sides of pubic symphysis.
Each approach describes a separate skin incision and. Oct 07, 2017 hernia 1 surgery for medical students learning surgery episodes hernia prof. This may include pain or discomfort especially with coughing, exercise, or bowel movements. The femoral triangle is a hollow area in the anterior thigh. The umbilicus belly button is in the center of the lower abdomen. Femoral hernias are relatively uncommon, however they are the most common incarcerated abdominal hernia, with strangulation of a viscus carrying significant mortality. Aug 01, 2016 laparoscopic surgery is a good choice for surgical treatment of hiatal hernia because of its miniinvasive nature and intraperitoneal view and operating angle.
An abdominal radiograph shows small bowel obstruction. Right femoral vein is elliptic, and hernia sac arrowhead lies in direction of minor diameter of right femoral vein solid white line. Apr 22, 2015 surgical anatomy of inguinal hernia 1. There is still much disagreement among surgeons and anatomists about the existence, structure, and function of these anatomic. A reducible femoral hernia occurs when a femoral hernia can be pushed back into the abdominal cavity, either spontaneously or with manipulation. If you are diagnosed with the strange occurrence, then you should rush down to the local retail outlet to purchase a lottery ticket because you. Complications from inguinal hernia surgery are rare and can include general anesthesia complications, hernia recur. When a femoral hernia is experienced, a portion of the intestine has moved into the femoral canal, which is. Classically three approaches are described to open femoral hernia repair. There is a high rate of strangulation and incarceration of bowel and richter hernias are common. In this article, we shall look at the borders, contents and clinical correlations of the femoral. This is the most common type of femoral hernia and is usually painless. The risk of strangulation in a femoral hernia is 22% at 3 months and 45% at 21 months.
Mar 23, 2020 a hiatal hernia is a protrusion of the abdominal contents into the thorax through an enlarged oesophageal hiatus caused by a weakness or opening in the diaphragm. Femoral hernias may not be noticed by the patient prior to strangulation, especially those who are obese. The surgeon should consider the operation in the context of the clinical anatomy of the abdominal cavity. The protrusion may extend outside the body or between cavities within the body, as when loops of intestine escape from the abdominal cavity into the chest through a defect in the diaphragm, the muscular partition between the two.
We think this is the most useful anatomy picture that you need. The anatomy of the inguinal region is enigmatic and confusing. We hope this picture femoral hernia anatomy diagram can help you study and research. Groin hernia can be classified into inguinal and femoral hernias. Hernia, protrusion of an organ or tissue from its normal cavity. It is the site through which vessels which provide nutrients to the fetus from the mother during development penetrate the fetal abdominal wall. Obturator hernia is relatively rare and typically affects frail, elderly, multiparous women. It often takes a specialist to determine what type of hernia is present and it may only be identified once surgery begins.
Inguinal hernias are often asymptomatic, presenting as a painless swelling in the groin. Details of the image small bowel obstruction due to an incarcerated femoral hernia modality. Umbilical hernias commonly contain fat, mesentery or small andor large bowel. Definitive preoperative diagnosis and strategic planning for. Anatomy front of the thigh femoral sheath part 5 dr. Diagnosis of inguinal region hernias with axial ct.
In addition, intestinal resection may need to be considered based on intestinal viability. The abdominal wall, a sheet of tough muscle and tendon that runs down from the ribs to the legs at the groins, acts as the bodys corset. Symptoms are present in about 66% of affected people. Open surgical repair of inguinal and femoral hernia in.
Hernia a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it. Over the past century, there has been a significant increase in the understanding of abdominal wall anatomy as it relates to inguinal and ventral hernia repairs. It acts as a pathway by which structures can pass from the abdominal wall to the external genitalia. If a loop or knuckle of intestine is within the hernia sac it requires immediate, emergency surgery. Strangulation of femoral hernias can occur because of the rigid boundaries of the femoral ring. The different types the most common location for hernia is the abdomen. Although the clinical anatomy of the inguinal region has traditionally been a focus for hernia surgeons, increasing attention is now applied to abdominal wall clinical anatomy for abdominal wall reconstruction. Femoral hernia queen elizabeth hospital birmingham. The most common type of ab dominal hernia is an inguinal hernia, which commonly presents with a lump in the groin. This intervention stops internal tissues from pushing through and causing a. In the 45 lesions, all hernia sacs were localized, and 42 lesions showed venous compression. Femoral hernias are ten times more common in women. Femoral hernias are a type of groin herniation and comprise a protrusion of a peritoneal sac through the femoral ring into the femoral canal, posterior and inferior to the inguinal ligament.
Therefore the essence of the clinical anatomy and treatment of femoral hernia is described. Studies were evaluated for the presence of hernia, the extent of the hernia sac based on the relationship between the hernia sac and pubic tubercle, and compression of the femoral vein venous compression. Mortality after groin hernia surgery pubmed central pmc. Femoral hernias protrude below inguinal ligament through the femoral canal below and lateral to pubic tubercle. Hernioplastyis the surgical repair of a hernia with mesh. It can be fat, bowel, or, in some cases, the genitourinary tract. The simple technique described in this paper can be a good alternative. Jun, 2016 an abdominal hernia is a defect in the wall of the abdominal cavity that allows protrusion of an organ or abdominal content through it. The inguinal canal is a short passage that extends inferiorly and medially, through the inferior part of the abdominal wall. A femoral hernia will appear as a bulge near the groin or thigh when your intraabdominal tissues push through a weakened spot in your muscle. A weak spot or other abnormal opening in a body wall permits part of the organ to bulge through.
The inguinal canal boundaries contents teachmeanatomy. Many large neurovascular structures pass through this area, and can be accessed relatively easily. Anatomy essentials for laparoscopic inguinal hernia repair ncbi. The sac may contain preperitoneal fat, omentum, small bowel, or other structures. A hernia is caused by the protrusion of a viscus in the case of groin hernias, an intraabdominal organ through a weakness in the containing wall. Femoral hernia sacs may well be easily identified within the femoral canal on coronal images, but identifying the neck of the hernia likely also requires confirmation on axial images. Surgical anatomy of the inguinal area springerlink. During exploratory surgery of the abdomen, an incidental finding was a herniation of bowel between the lateral edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric vessels. Uracs accreditation program is an independent audit to verify that a. Critical to the repair of richters hernia is an adequate evaluation of the intestine for viability. Inguinal hernia knowledge for medical students and.
The essential components of a femoral hernia repair include dissection and reduction of the hernia sac and closure of the defect either through approximation of. Femoral hernia repair is a procedure to fix the weak portion of the muscle wall. A femoral hernia appears as a bulge in the groin, upper thigh, or labia skin folds surrounding the vaginal opening. This article will talk about the surgical procedures, technical details, precautions and complications about laparoscopic hernioplasty of hiatal hernia. A hernia is strangulated when the blood supply to the intestine or hernia sac is decreased. A hernia may develop in various parts of the body, most commonly in the region of the abdomen. The goal of this activity is to define current treatment protocols and clinical strategies and describe stateoftheart materials and techniques used in the surgical management of inguinal hernias. Protrusions of the abdominal contents through the weak areas in this region are grouped under groin hernias. Sarela consultant surgeon st jamess university hospital, leeds. If you have a simple sliding hiatal hernia repaired laparoscopically you can frequently be discharged the same day.
Femoral hernias protrude below inguinal ligament through the femoral canal below and lateral to. She is admitted to the surgical ward with a diagnosis of obstructed femoral hernia and has a small bowel resection and emergency hernia repair. Treatment is usually via elective, minimally invasive, laparoscopic surgery. The surgeons understanding of the anatomy of the anterior abdominal wall is critical for successful hernia repair. Each lower image is magnification of upper portion on each side. Discussion many techniques for femoral hernia repair have been described to date with a variety of clinical outcomes. Doctor answers on symptoms, diagnosis, treatment, and more. Inguinal and femoral hernias inguinal canal anatomy.
The femoral artery, femoral vein, and femoral canal travel through this path. Ashraf khater professor of surgery and oncosurgery, mansoura university, eg. Most obturator hernias contain small intestine, usually a knuckle of ileum. Strangulated hernia the compression around the hernia prevents blood flow into the hernial contents causing ischaemia to the tissues and pain. Since an understanding of the anatomy of this region is comparable to an understanding of the basic factors behind the clinical anatomy of the entire abdominal cavity, the essence of the clinical anatomy and treatment of femoral hernia are described. Jan 30, 2015 mr mike rafferty gives a comprehensive overview of the anatomy of hernias. Bowel obstruction is common and can be also be complicated by bowel ischemia.
Introduction no disease from the human body, belonging to the domain from the surgeon, demands in its treatment, a better mixture of precise, anatomical knowledge along with surgical skill compared to hernia in most its variations. Start studying anatomy of indirect inguinal hernia. Femoral hernia is a kind of ventral hernia that surgeons commonly encounter, second in frequency only to inguinal hernia. Surgery hernia protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains congenital, acquired most have an expansile cough impulse. I think it is best to first look at the basic anatomy of the inguinal canal to aid. In the swedish hernia register shr, 2 each hernia operation is prospectively followed. If you have a more complex paraesophageal or foramen of bochdalek hernia expect to be admitted to the hospital. Pdf preperitoneal approach for femoral hernia repair kanito.
These defects most commonly involve the anterior abdominal wall, particularly at sites considered weak as the inguinal, femoral, and umbilical areas. If a portion of tissue pushes through the wall of the femoral canal, its called a femoral hernia. Young indirect old age weak musculature direct history occupation strenous strenous work persistent processus. Inguinal and femoral hernias inguinal canal anatomy geeky. The estimated time for bowel viability survival is about 812 hours. Pdf on jan 1, 20, makio mike and others published femoral hernia. Other uncommon complications of femoral hernia repair include. Muscles of the anterior abdominal wall contd the two vertical muscles are. Groin hernias inguinal and femoral hernia epomedicine.
There are inherent limitations to ct in detection and grading the severity of these hernias. Get a printable copy pdf file of the complete article 1. The four types of hiatal hernias are sliding, paraesophageal, mixed and giant hiatal hernia. The classification and diagnosis of inguinal and femoral hernias, management of inguinal and femoral hernia, and laparoscopic techniques for inguinal and femoral hernia repair are discussed elsewhere. A femoral hernia is the protrusion of a peritoneal sac through the femoral ring into the femoral canal, posterior and inferior to the inguinal. Sonographic appearance of the inguinal ligament ultrasound imaging documentation. A history of previous episodes of acute obstruction followed by remission is common. Femoral hernia a hernia is caused by the protrusion of a viscus in the case of groin hernias, an intraabdominal organ through a weakness in the containing wall.
Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient. This is very much greater than for an inguinal hernia. Aug 15, 2017 an inguinal hernia is the protrusion of intraabdominal contents through a defect in the abdominal wall. Among the many structures involved in hernial repair are the iliopubic tract, the transversus abdominis aponeurosis and the transversalis fascia, the transversalis crura and sling, and the inguinal canal. The femoral sheath is a path that leads from the abdominal cavity to the thigh. Direct inguinal hernias, oblique inguinal hernias and femoral hernias are all caused by weakness of the abdominal transverse fascia in myopectineal orifice. An inguinal hernia is an abnormal protrusion of intraabdominal contents either through the deep inguinal ring indirect inguinal hernia. Anatomy and management is intended for general surgeons and hernia specialists. A femoral hernia will be protruding from the femoral canal just lateral to the pubic tubercle, below the inguinal ligament. Femoral hernias often require emergency surgery because of incarceration or strangulation of the intestine. Anterior abdominal hernias rectus sheath superficial inguinal ring femoral canal.
Differences in opinions between the two radiologists regarding the ct findings were settled by. Anatomy and pathophysiology of hernias abdominal key. Strangulation eventually occurs, and surgical intervention is the only effective treatment. An indirect inguinal hernia forms as a result of the failure of the processus. Femoral hernias often require emergency surgery because of incarceration or strangulation of the intes tine. Pdf differentiation of a femoral hernia from an inguinal. Congenital inguinal hernia direct inguinal hernia femoral hernia indirect inguinal hernia. The basic format of the peritoneal configuration of the. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. A femoral hernia is a loop of intestine, or another part of the abdominal contents, that has been forced out of the abdomen through a channel called the femoral canal a tubeshaped passage at the top of the front of the thigh. We propose a technique for open femoral hernia repair that involves a single skin incision 1 cm above the medial half of the inguinal ligament that allows all of the above approaches to the hernia sac depending on the operative findings.
Familiarity with these anatomic differences at axial. The anatomy of the inguinal region authorstream presentation. Go to step 29treat the hernia an enlarged femoral lymph node will dissect out completely. The inguinal canal is a short passage that extends inferiorly and medially, through the. Small bowel obstruction due to an incarcerated femoral. Femoral hernias characteristically appear as a round, often tender bulge in the groin in the medial region of the femoral triangle just inferior to the pubic tubercle. Estimates hold that less than 3 percent of the population will suffer such an oddity. A femoral hernia will appear as a bulge near the groin or thigh. The femoral canal lies below the inguinal ligament. Femoral hernia definition of femoral hernia by medical.
201 798 454 568 1073 1432 187 1305 19 140 123 1375 325 1351 754 580 493 761 58 412 1190 1449 1664 412 551 1478 1457 335 34 705 300 1193 606