Femoral Hernia-

Femoral Hernia

the femoral hernia is more common in women than in men because of a wider pelvis and femoral canal . The neck of the hernial sac lies below and lateral to the pubic tubercle.

The hernial sac passes down the femoral canal, pushing the femoral septum before it. On escaping through the lower end, it expands to form a swelling in the upper part of the thigh deep to the deep fascia. With further expansion, the hernial sac may turn upward to cross the anterior surface of the inguinal ligament.

The neck of the sac always lies below and lateral to the pubic tubercle , which serves to distinguish it from an inguinal hernia. The neck of the sac is narrow and lies at the femoral ring. The ring is related anteriorly to the inguinal ligament, posteriorly to the pectineal ligament and the pubis, medially to the sharp free edge of the lacunar ligament, and laterally to the femoral vein. Because of the presence of these anatomic structures, the neck of the sac is unable to expand. Once an abdominal viscus has passed through the neck into the body of the sac, it may be difficult to push it up and return it to the abdominal cavity (irreducible hernia). Furthermore, after straining or coughing, a piece of bowel may be forced through the neck and its blood vessels may be compressed by the femoral ring, seriously impairing its blood supply (strangulated hernia). A femoral hernia is a dangerous disease and should always be treated surgically.

The hernial sac descends through the femoral canal within the femoral sheath, creating a femoral hernia. The femoral sheath, is a protrusion of the fascial envelope lining the abdominal walls and surrounds the femoral vessels and lymphatics for about 1 in. (2.5 cm) below the inguinal ligament . The femoral artery, as it enters the thigh below the inguinal ligament, occupies the lateral compartment of the sheath. The femoral vein, which lies on its medial side and is separated from it by a fibrous septum, occupies the intermediate compartment. The lymph vessels, which are separated from the vein by a fibrous septum, occupy the most medial compartment. The femoral canal, the compartment for the lymphatics, occupies the medial part of the sheath. It is about 0.5 in. (1.3 cm) long, and its upper opening is referred to as the femoral ring. The femoral septum, which is a condensation of extraperitoneal tissue, plugs the opening of the femoral ring.