Femoral Hernia
A hernia is a bulge that forms when the organs of the abdominal cavity push out through a weakened area in the abdominal wall. The muscles of your abdominal wall are strong and tight enough to keep the internal organs in place; but muscle weakness, previous abdominal surgery or induced pressure in the abdominal wall may result in a hernia.
A femoral hernia is a bulge that forms when a part of the peritoneal sac (abdominal wall), consisting of fatty tissue, intestine or other structures, protrudes and is visible just below your lower abdomen and upper thigh, near your groin crease or labia (skin folds around the vagina). The bulge is pushed into your femoral canal, which is medial to the nerves and blood vessels that run into the thigh region.
Femoral hernias are an uncommon type of hernia (only one in every 20 hernias of the groin). Femoral hernias commonly occur in women, mostly older women, because they have a wider pelvis and a larger femoral canal than men. They are rarely seen in children. Femoral hernias can sometimes manifest suddenly due to increased abdominal pressure while straining during constipation or when pushing or carrying heavy objects. Other causes include obesity, pregnancy or a persistent cough.
Femoral hernias are often mistaken for an inguinal hernia, and when diagnosed, should be treated as an emergency condition.
What are the signs & symptoms?
Small or moderate femoral hernias generally are asymptomatic and in some cases even a bulge may not be visible. However, large femoral hernias may manifest as a bulge, which may get larger on coughing or straining, and can be associated with discomfort. Large hernias may cause pain when exerting pressure, while standing up or lifting heavy objects. Some other symptoms include:
- Hip pain due to closeness of the hernia to the hip region
- Numbness or irritation due to pressure placed on the nerves in the femoral canal
If you experience severe abdominal or groin pain or if the bulge is reddish and tender, there may be a chance your intestine is obstructed (stuck in the femoral canal) or strangulated (trapped). Strangulation may block blood flow to the part of your intestine that is stuck and cause tissue necrosis (death of tissue), which may endanger your life. A trapped or obstructed femoral hernia may cause the following symptoms:
- Groin pain
- Nausea or vomiting
- Abdominal pain
Presence of these symptoms requires an emergency hernia repair to release the trapped tissue.
What are the methods of screening & diagnosis?
Physical examination is the first line of diagnosis to test the external femoral bulge, however your doctor may find it difficult to feel if it’s small in size. The bulge will be examined for its texture, size and protrusion. Your doctor will also check for skin discolouration, inflammation or dark patches on the surface of the bulge to rule out gangrene (death of tissue).
If the hernia cannot be detected with a physical examination, your doctor may order an ultrasound of the abdomen or groin. Other imaging tests such as diagnostic X-rays, magnetic resonance imaging (MRI) or a computer tomography (CT) scan may be performed to check for the protruding issue.
What are the treatment options?
Femoral hernias usually require surgical repair due to its high risk of bowel obstruction or strangulation (trapped). Your surgeon will push the bulged organ back into its place and close or provide support to the weakened area of the abdominal cavity.
Your surgeon may perform either open or laparoscopic surgery to repair the femoral hernia, which are usually performed under general anaesthesia.
Open surgery:
During the procedure, a single 3 to 4 cm long incision will be made over the bulge or in your lower abdomen and the bulge will be separated from the surrounding tissues. Your surgeon may remove any excess tissue if required. The part of the protruding peritoneal sac will be pushed back into the abdomen and the muscles of the weakened abdominal wall may either be stitched (herniorrhaphy) or a piece of mesh will be sutured (hernioplasty) in place to strengthen it.
Bowel resection (removal of a part of the intestine) may be required during an open surgery if the intestine is trapped and damaged inside the bulge. Your surgeon will cut off the damaged bowel and rejoin the ends of the healthy bowel.
Laparoscopic surgery:
During laparoscopy, your surgeon will make three small incisions on the abdominal wall. A laparoscope (thin tube with a lighted device and a camera on its end) is inserted through one of the incisions and special surgical instruments are placed in through the other incisions. The peritoneal sac is pushed back in place and the defect in the muscles of the abdominal wall is repaired by using mesh (hernioplasty).
