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Acute Care Emergency Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Marcelo A. F. Ribeiro, Mansoor Khan
The definitive treatment of all hernias regardless of their origin or type is surgical repair. In a situation of limited resources, the surgeon will need to perform an open repair and, if available, utilise a mesh. If no mesh is at hand, the Shouldice repair (more complex and time-demanding) or a Bassini repair with a McVay relaxing incision are alternatives. In cases of femoral hernias – which count for less than 10% of all the groin hernias but represent 40% of hernia emergencies – the Lichtenstein repair cannot be used since it does not address the femoral ring. In these cases, the McVay technique is still considered the most appropriate.
Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Contents (lateral to medial)Femoral nerve – invested in fascia iliacaFemoral branch of the genitofemoral nerveFemoral sheath – a prolongation of the transversalis fascia containing Femoral arteryFemoral veinFemoral canal – the medial component of the sheath containing lymphatics and possibly inguinal node (Cloquet’s node). The femoral ring is the abdominal opening of the canal.
General Surgery
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Femoral hernias are almost always surgically managed due to their high risk of strangulation. The procedure involves reduction of the hernia and surgical narrowing of the femoral ring using sutures. Specific complications of surgery include damage to the femoral vessels (the vein is nearest the hernia) and the femoral nerve.
De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases
Published in Acta Chirurgica Belgica, 2022
Michail Chatzikonstantinou, Mohamed Toeima, Tao Ding, Almas Qazi, Niall Aston
The femoral canal is the most medial compartment of the femoral sheath, which is bordered anterosuperiorly by the inguinal ligament, medially by the lacunar ligament, laterally by the femoral vein and posteriorly by the pectineal ligament. It contains fat lymphatics and the lymph node of Cloquet. A large mobile caecum that extends into the pelvis is the usual reason for the appendix to enter the hernia sac into the femoral ring [13–15]. The abnormal low position of the bowel creates a mass effect that pushes the appendix into the femoral canal, while an abnormal embryological rotation of the gut increases the probability of appendiceal herniation. Intraoperative findings of normal non-inflamed appendix favour the theory of herniation of the appendix and subsequent inflammation rather than incarceration of an already inflamed appendix. The tight rigid femoral ring acts as an entrance to an anatomically confined space for strangulation, inflammation and, eventually, vascular congestion, necrosis and perforation of the appendix.