In abdominal surgery (operative Gastroenterology) Femoral hernia occurs in 5-8% of the total number of abdominal hernias. Femoral hernia is more common in women (ratio of men 4: l) due to the anatomical features of the structure of the pelvis, and the first year of life due to the physiological weakness of the abdominal wall of the connective tissue. Femoral hernia is formed by the output of the abdominal cavity (omentum, bowel loops) outside the abdominal wall through the pathological femoral canal. Femoral hernias are insidious course and is often violated.
The components of the femoral hernia presented hernia gate, hernia sac and hernial contents. Gate femoral hernia is the femoral canal - in the course of the pathological musculo-fascial space of the femoral triangle. The femoral canal is the inner hole (femoral ring), the external opening (oval hole) and a wall formed by the inguinal ligament, fascia lata, the wall of the femoral vein. Femoral canal length is 2-3 cm in the vertical direction.
Hernial bag femoral hernia preperitoneal fiber is formed, the transverse fascia, vascular fiber gaps, lattice fascia. Hernia contents of the bag with the femoral hernia usually serve the greater omentum and small bowel loop, at least - large intestine (cecum and appendix - right, sigmoid - left), bladder, ovary with the fallopian tubes - for women, the egg - in men.
dislocation of the hip (in Vol. h. congenital).
By directly generating factors include situations related to an increase in intra-abdominal pressure: Physical effort, difficulty in urination, persistent cough, constipation, prolonged labor, etc. These factors may act singly (eg, weight lifting) and long (prolonged cough whooping cough, chronic bronchitis).
infringement of femoral hernia dangerous condition may develop: acute intestinal obstruction, necrosis or gangrene of the intestine, peritonitis.
Depending on the location of formation of the femoral canal hernia distinguish vascular lacunae (lateral, vaginally, total) and muscle hernia gap (hernia Gasselbaha).
During the formation of the femoral hernia are three stages: initial, incomplete and complete. In the initial stage of the hernial sac is located outside the inner ring of the femoral. At this stage, femoral hernia difficult to distinguish clinically, but may be accompanied by parietal (Richter) infringement. With incomplete (channel) stage hernial protrusion is within the femoral canal, within the boundaries of the superficial fascia. Full output stage is characterized by herniation of the femoral canal in the subcutaneous fat thighs, sometimes - sexual lips in women and the scrotum in men. Typically, femoral hernia is diagnosed in the full stage.
When strangulated femoral hernia develops acute disturbance of blood supply and innervation of the organs that make up the hernial contents. This hernia increases in size, becomes nevpravlyaemoy, dense, sharply painful to palpation. There are severe pain in the infringement or around the stomach, develops delayed stool and gas. Long infringement femoral hernia can lead to necrosis of the organs and the development of intestinal obstruction. In this case, there is a hiccup, nausea, repeated vomiting, cramping.
lipoma, lymphadenitis, wandering abscess, varicose veins, thrombophlebitis, aneurysms of the femoral artery, malignant tumors metastases.
To determine the contents of the hernia sac is held ultrasound scanning herniation, barium enema, ultrasound of the bladder and pelvis.
The surgery developed a lot of methods and operational procedures of modifications that, depending on the access are divided into the inguinal (method Rudge, Parlavechchio) and femoral (method Bassini, Lockwood, Herzen, and others.), And by the process of closing the hernial ring can be simple and plastic .
Operation at the femoral hernia involves dissection of the hernia sac, check the contents, if necessary - modified resection gland, reduction of hernia contents into the abdominal cavity, ligation and excision of the hernia sac and hernia plastic channel. Hernia repair can be performed using the patient's own tissue or synthetic materials (polymer network).
When strangulated femoral hernia may need to perform midline laparotomy with resection of nonviable bowel area.
Prediction and prevention of femoral hernia
In most cases, neuschemlennoy femoral hernia good prognosis. The greatest number of recurrences seen with femoral hernia repair methods. If left untreated, it can form nevpravimaya femoral hernia, in 82-88% of cases there is infringement.
Prevention of femoral hernia is to strengthen the muscles of the anterior abdominal wall, the limitation of physical activity, wearing a brace during pregnancy, nutrition, elimination hacking cough. To prevent life-threatening complications allows the earliest possible radical treatment of femoral hernia.