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Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Sophia Abdulhai, Todd A. Ponsky
A femoral hernia is a protrusion of preperitoneal fat or viscus through a defect in the femoral canal. It is not a common hernia in children but must be considered with a swelling in the inguinal region with the bulge inferior to the inguinal ligament. Femoral hernia may occasionally be confused with an enlarged swollen infected lymph node near the saphenofemoral junction (lymph node of Cloquet) just inferior to the inguinal ligament. Careful examination for a lower extremity focus of infection should be performed. Unfortunately, femoral hernias are often misdiagnosed and treated as inguinal hernias and therefore present following “recurrence.”
Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
How do you distinguish clinically between the inguinal and femoral hernia when you see a lump in the groin?Inguinal hernia comes out superior/medial to the pubic tubercle while the femoral hernia comes out inferior/lateral to the pubic tubercle.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
A hernia is simply a protrusion of a viscus, or part of a viscus, outwith its normal position. A femoral hernia can be distinguished from an inguinal hernia by its position. An inguinal hernia lies above and medial to the pubic tubercle, while a femoral hernia lies below and lateral to the pubic tubercle. The pubic tubercle is thus an important landmark in differentiating a femoral from an inguinal hernia. In addition, an inguinal hernia may be either direct or indirect. A direct hernia passes straight through a weakness in the anterior abdominal wall and passes through the superficial ring only. An indirect hernia, in contrast, passes through both the deep and superficial inguinal rings and thereby passes along the entire length of the inguinal canal.
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
Acute presentation of an incarcerated femoral hernia constitutes a surgical emergency. Incarceration and strangulation are more common in female patients aged 65 and over. Herniation of the vermiform appendix is not common and difficult to detect preoperatively. CT of the abdomen and pelvis is the most common investigation and the investigation of choice in clinical uncertainty. The procedure of a repair of a De Garengeot’s hernia varies, depending on the clinical expertise of the operating surgeon. There are various surgical approaches described in the literature. The majority of published cases underwent an open procedure via an inguinal or infra-inguinal incision. In case of difficulty accessing the base of the appendix a second incision had to be made. The intraoperative findings are in favor of acute appendicitis, and, thus, the hernia was repaired with sutures. The surgical incision is based upon the surgeon’s preference and experience.
Tipp versus the Lichtenstein and Shouldice techniques in the repair of inguinal hernias – short-term results
Published in Acta Chirurgica Belgica, 2021
Aleksandar Djokovic, Samir Delibegovic
In the case of a direct hernia, the preperitoneal space is dissected through the dilated transverse fascia. We begin dissection above the pubic tubercle and push the peritoneum upwards and medially. In order to position the mesh well, the dissection must be made right up to Cooper’s ligament and the pubic bone must be felt. During this preparation, any non-diagnosed femoral hernia may be identified and treated using the same procedure. Dissection of the hernia sac and funiculus must be performed up to the point where the sperm duct and the blood vessels divide, so that the tunica of funiculus may be easily closed. Placing the mesh is facilitated by a memory ring patch (Polysoft, Davol Inc., C.R. Bard Inc., Crowley, UK). First, it is placed medially behind the Cooper’s ligament and then laterally up to the internal ring (Figure 2) [14].