Femoral hernia in men symptoms photo. Protrusions in the groin - femoral hernia in women, symptoms, types, treatment

Femoral hernia occurs much less frequently in men than in women and children. The pathology is a small formation that occurs when intestinal loops protrude and are displaced from the omentum outside the abdominal cavity.

Causes

Provoking factors for the occurrence of a femoral hernia are congenital intestinal pathologies, as well as postoperative scars. An additional role is played by inflammatory kidney diseases, which contribute to difficulty urinating.

Causes of the problem:

• lifting weights;
• prolonged constipation, creating excessive abdominal pressure;
• rapid weight loss;
• abdominal trauma;
• lack of physical activity.

Diagnosis of femoral hernias

Diagnosis of a femoral hernia includes a mandatory examination of the patient, the doctor assesses the size of the protrusion.

Research methods:

• irrigoscopy. The patient is injected with a barium suspension, which is a radiopaque substance and allows one to obtain a detailed picture of the pathological process;
• Ultrasound. Scanning the hernial sac allows you to determine the severity of the problem;
• palpation and percussion (tapping). The hernia is soft to the touch. When tapping, the doctor may hear a dull sound, indicating that the sac contains a dense organ, such as the omentum.

Symptoms

Symptoms of a femoral hernia depend on the type of protrusion and the severity of the disease. At the initial stage of development, any signs may be absent.

Symptoms:

• pain in the groin area, the presence of a tumor (or edema) in the area of ​​the pathological process;
• feeling of numbness in the skin of the abdomen;
• stool retention and flatulence;
• discomfort in the hip area, especially during movement.

With intestinal obstruction, dyspeptic disorders appear: nausea and vomiting, as well as intense pain in the abdominal cavity. If the bladder is involved in the process, urine stagnation occurs.

Classification of hernias and stages of formation

Femoral hernias are divided according to location into bilateral and unilateral. According to the nature of the flow, the formation can be:

1. Reducible. It easily returns to the abdominal cavity with little effort on the part of the doctor.
2. Irreversible. May only partially return to the abdominal cavity or remains unchanged.
3. Disadvantaged. This type of pathological process is characterized by compression of organs located within the hernial canal. This form of the disease is dangerous due to the development of peritonitis, gangrene and necrosis of intestinal tissue. Inflammation of organs occurs, which are under pressure from the formation itself.

There are 3 stages of development of a femoral hernia:

1. Initial. At this stage, the formation is not visualized and practically does not manifest itself in any way. In rare cases, pinching may be felt on the right or left side in the lower quadrant of the abdomen.
2. Incomplete. Such a formation is located beyond the boundaries of the fascia and is not yet expressed, although the corresponding symptoms are already present.
3. Complete. In this case, the hernia protrudes beyond the fascia and descends into the subcutaneous tissue. In men, the formation may move into the scrotum.

Complications

The most dangerous complication of a femoral hernia is the death of intestinal tissue. In this case, the pain becomes unbearable, and acute stool retention occurs. If this happens, then surgery is indicated to remove not only the protrusion, but also some fragment of the intestine. With the development of a purulent process, the contents can spread throughout the subcutaneous tissue, leading to painful shock. Inflammation of neighboring organs and tissues occurs. If you ignore the symptoms and do not consult a doctor in time, death is possible.

Surgical treatment

It is impossible to eliminate a femoral hernia in men without surgery. Hernioplasty is the most common and effective type of intervention. After opening the hernial sac, the specialist evaluates its contents. If necessary, resection of the omentum is performed. Then the formation itself is excised, and the canal undergoes plastic surgery and further reduction. In this case, most often the incision is made in the area of ​​the femoral triangle.

During surgery, polymer meshes or the patient’s own tissue are often used. This measure is necessary to close the hernial orifice.

The mesh protects the femoral canal from further expansion. The operation can be performed in two ways: open and closed. With the first, access is made through an incision, and with the second, the intervention is through several small punctures.

Preparation

Preparation for surgery, which will be carried out in the hip or groin area, consists of a mandatory check of the activity of the cardiovascular system and a study of blood clotting ability in order to reduce the risk of developing life-threatening complications for the patient.

Before surgery for a femoral hernia, the patient must undergo an ultrasound and ECG. Additionally, urine and blood are collected to assess the condition of the body and the presence of contraindications. The doctor asks the patient about cases of allergic reactions to drugs. The day before the intervention, you should stop eating and drink only water.

Rehabilitation

Rehabilitation after surgery for a femoral hernia includes:

• compliance with bed rest;
• lack of physical activity on the abdominal muscles for several months or six months;
• balanced diet, including dairy products, cereals, fish, vegetables and fruits. A person should consume food containing large amounts of vitamins;
• full sleep. During the recovery period, a man must rest at least 9 hours a day;
• regular seam treatment. In the first week after the intervention, you must be under the supervision of a doctor and monitor the cleanliness of the operated area.

A femoral hernia is a protrusion of some abdominal organs outside the abdominal cavity, resulting in a tumor-like formation appearing above the skin of the thigh. The size of the resulting protrusion depends on how many internal organs have penetrated through the femoral ring into the hernial sac. In most cases, the greater omentum and part of the intestinal loop emerge from the peritoneum, but sometimes also the appendix, cecum, sigmoid colon, bladder, in women - the ovary, in men - the testicle.

According to medical statistics, femoral hernias account for about 10% of cases among all abdominal hernias. Women suffer 4 times more often than men, which is explained by the structural features of the pelvis, as well as postpartum complications. Often this pathology occurs in children under 1 year of age due to the fact that the tissues of the abdominal wall that contain the internal organs have not yet fully strengthened.

Symptoms of a femoral hernia

• A sac-like protrusion in the area of ​​the inguinal-femoral fold, usually directly under the inguinal fold. The protrusion has a smooth surface, a semicircular shape, and is more noticeable when the body is in an upright position. The hernial sac can be pushed into place, and the rumbling of the intestine can be heard.
• Pain in the hip area.
• Increased pain when coughing, straining, palpating.
• Numbness of the leg, feeling of “crawling goosebumps”.
• If the bladder is damaged, there is frequent urination, accompanied by severe pain and stinging.
• Sometimes - swelling of the lower limb.
• As a result of a strangulated hernia, the pain intensifies, spreads throughout the entire abdominal region, problems with stool, hiccups, nausea occur, and body temperature rises.

Reasons for education

The cause of a hernia can be trauma to the abdominal region resulting from an accident or a blow to the stomach, hip dislocation (including congenital), complications in women during childbirth, hereditary weakness of the peritoneal muscles (usually manifested in children under 1 year of age). Also, the formation of a tumor-like protrusion is often caused by lifting heavy weights, while for the appearance of a hernia one such unbearable load is enough, which can injure the muscles of the abdominal cavity.

In addition, it is worth highlighting a number of factors that increase the risk of this disease:

• Rapid weight loss – as a result, weakness of the peritoneal muscles appears.
• Several pregnancies in a row - after childbirth, the abdominal muscles are weakly elastic.
• Scars after surgery – it takes time for the abdominal muscles to recover.
• Tendency to constipation, difficulty urinating.
• Protracted cough - with chronic bronchitis, whooping cough, as well as in heavy smokers.
• Other factors that increase intra-abdominal pressure are physical activity at work, exercise in the gym, etc.

Often, a femoral hernia occurs in children under 1 year of age - due to weakness of the peritoneal muscles, the cause can be falls, constipation, prolonged crying, etc. When a child begins to roll over, actively move, sit and crawl, the abdominal muscles become stronger - the risk of a hernia is significantly reduced . Accordingly, infants need to do massage and gymnastics to strengthen their muscles - this applies not only to the abdomen, but also to other parts of the body.

Stages of pathology development:

1. Initial - the hernia remains within the inner ring. It is asymptomatic.
2. Canal - the tumor moves to the anterior wall of the thigh. The symptoms are very difficult to diagnose.
3. Complete – the appearance of a protrusion, the symptoms are obvious.

Kinds

• By localization - unilateral and bilateral hernias.
• According to the clinical picture - reducible, irreducible and strangulated. A strangulated hernia can lead to peritonitis, intestinal obstruction, necrosis, and intestinal gangrene.
• Depending on the location of the formation of the femoral canal - hernia of the vascular lacuna and muscle lacuna.

Diagnostics

In the early stages of the disease, diagnosis is difficult. When a hernia already protrudes and begins to bother a person, it is not difficult to recognize it. During the initial examination, the doctor will ask the patient about the symptoms noticed, assess the reducibility of the hernia, as well as the symptom of a cough impulse. Additional studies are prescribed: auscultation of peristaltic sounds, determination of tympanitis (loud sound), ultrasound scanning of the hernial sac, X-ray examination of the colon (irrigoscopy), ultrasound of the bladder, etc.

Differential diagnosis includes an abscess, thrombophlebitis, inguinal hernia, femoral artery aneurysm and some tumors.

Treatment

It makes no sense to treat a femoral hernia with injections or tablets, i.e. An operation is required - opening the hernial sac, after which plastic surgery of the hernial canal (hernioplasty) is performed. Depending on the chosen access to the hernia, operations can be inguinal and femoral, depending on the method of closing the hernia orifice - plastic or simple.

The operation is performed in several stages:

1. Opening the hernial sac and examining the contents.
2. Repositioning the contents into place in the abdominal cavity.
3. Excision of the hernial sac.
4. Hernial canal plastic surgery. Hernioplasty is performed using both patient tissue and polymer meshes.
5. If a strangulated hernia is detected, then in some cases a midline laparotomy is performed followed by removal of the strangulated part of the intestine.

Prognosis and prevention

In general, the prognosis is favorable - patients return to a full life after surgery. Relapses after surgery more often occur with femoral access to the hernia. If the pathology is not treated, then complications arise - the hernia becomes irreducible, and in 9 cases out of 10 - strangulated.

Prevention should be aimed at strengthening the abdominal and abdominal muscles: avoiding abdominal injuries, lifting heavy weights, limiting physical activity at work and in the gym, proper nutrition, wearing a support bandage during pregnancy, fighting smoking, chronic bronchitis, etc.

When diagnosing a femoral hernia, you should not be afraid of surgery. The sooner surgery is performed, the lower the risk of a strangulated hernia, which leads to dangerous complications.

Femoral hernia- a condition in which the abdominal organs (intestines, greater omentum) extend beyond the anterior abdominal wall through the femoral canal.

Under normal conditions, the femoral canal does not exist. It is formed during the formation of a femoral hernia.

Between the inguinal ligament (a connective tissue cord between the ilium and the pubis) and the pelvic bones there is a space containing vessels and nerves emerging from the pelvis and serving for blood supply and innervation of the lower limb. Next to the vein there is a gap that is filled with fairly loose connective tissue. This gap is called the femoral ring, through which, under certain conditions, the abdominal organs can emerge, i.e. femoral hernias form. The contents of the hernial sac are usually a loop of the small intestine, the omentum. Less commonly, the large intestine emerges into the hernial sac (on the right - cecum, on the left - sigmoid). Femoral hernias are rarely large and are prone to strangulation.

Classification of femoral hernias.

There are many classifications of femoral hernias, but the division of hernias according to the possibility of reduction and strangulation is of particular importance for the choice of treatment method.

Reducible hernias, in which the hernial contents can be easily reduced into the abdominal cavity.

Irreversible hernias, which are only partially reduced or not reduced at all.

Strangulated hernias. Strangulation should be understood as sudden compression of the hernial contents in the hernial orifice.

It is especially important to distinguish strangulated hernias from irreducible ones, since strangulation threatens the development of acute intestinal obstruction, necrosis and gangrene of the intestine, peritonitis and requires emergency surgery. Manifestations of a femoral hernia.

Stages of femoral hernia formation

During the formation process, a femoral hernia goes through three stages: initial, canal and complete.

In the initial stage, the hernial protrusion does not extend beyond the internal femoral ring.

In the incomplete (canal) stage, the hernial protrusion is located near the vascular bundle and does not penetrate the subcutaneous tissue of the thigh. Identifying incipient and canal femoral hernias can be difficult.

Such hernias can be suspected only on the basis of a child’s complaints of unpleasant sensations in the groin, lower abdomen, upper thigh, which intensifies with walking, physical activity, or changes in weather. But, at the same time, the child may not be bothered by anything, so often the resulting strangulation is the first clinical manifestation of such hernias.

In the full stage, the femoral hernia passes through the entire femoral canal and exits through its external opening under the skin of the thigh.

Femoral Hernia Clinic

Characteristic clinical signs of a complete femoral hernia are a hernial protrusion in the area of ​​​​the border between the groin and thigh in the form of a small hemispherical formation located under the inguinal ligament. A hernial protrusion appears with a vertical position of the body, straining, and disappears when repositioned, sometimes with a rumbling sound. A sign of a hernia is also the symptom of a cough impulse, which can be positive even in the initial form of a hernia.

The clinical picture of a strangulated hernia, both in the inguinal and femoral, is similar and is most often determined by which organ is strangulated. With a reducible hernia, the latter ceases to be reduced, the child is restless and complains of severe pain in the area of ​​the hernial protrusion or in the entire abdomen. The protrusion increases, becomes tense, sharply painful when touched, mainly at the neck. Stool and gases are retained. At first the stomach is soft. Subsequently, as intestinal obstruction develops due to intestinal strangulation, the pain increases, becomes cramping in nature, nausea, hiccups, and repeated vomiting appear. With the development of peritonitis (inflammation of the peritoneum), bloating and muscle tension in the anterior abdominal wall appear.

Sometimes the clinic is not so typical and symptoms may not appear for a long time. Therefore, the child’s parents need to be vigilant and, if any protrusion appears in the lower abdomen or upper thigh, immediately consult a doctor.

Diagnostic methods.

Diagnosis in the initial stages, due to the mild manifestations of the disease, presents certain difficulties.

The study begins with a thorough interview of the parents, after which the child is examined. If necessary, in order to clarify the composition of the hernial sac, additional examination methods are carried out, such as ultrasound examination of the hernial protrusion, X-ray examination of the digestive tract, bladder, ovaries, to exclude the entry of these organs into the hernial sac.

Diagnosis of a strangulated hernia is usually simple. Difficulties arise with small parietal hernias, especially in obese patients. Careful examination of symptoms of peritoneal irritation in combination with local tenderness in the inguinal or femoral canal helps to make the correct diagnosis. If, upon examination of a child with an irreducible hernia, the slightest suspicion of strangulation arises, he should be immediately taken to a surgical hospital.

Treatment of femoral hernias.

Treatment of femoral hernias, due to their very frequent strangulation and lack of effect from drug therapy, is surgical. The operation is somewhat more difficult than for inguinal hernias.

The essence of the operation for femoral hernias also consists in isolating, opening and removing the hernial sac, reducing its contents (most often it is a loop of intestine) and suturing the resulting defect.

There are several methods of surgical treatment of femoral hernias. The choice of one method or another depends on the type of femoral hernia and on the choice of the surgeon himself.

The indication for surgery is an established diagnosis of a hernia and the child reaching the age of 1 year. In children under 1 year of age, repeated strangulations are indications for hernia repair.

The main purpose of the operation is the isolation and high excision of the hernial sac. It is most often performed in young children under general anesthesia, and in adults under local anesthesia.

Methods of surgical treatment

plastic surgery with local tissues - consists of suturing the defect of the femoral canal with a synthetic non-absorbable thread using the patient’s own tissues using the Ruggi-Parlavecchio method.

plastic surgery using synthetic prostheses (mesh) (Lichtenstein). - in this case, the synthetic prosthesis can be placed preperitoneally, and suturing of the femoral canal is not performed.

Bassini method, hernioplasty

A femoral hernia is nothing more than a pathological condition of the muscles, in which they are discharged with the formation of a femoral ring.

In this case, the internal organs located in the abdominal cavity fall out into the resulting hole. “Outside” is a conditional term, since outwardly the disease manifests itself in the form of a kind of protrusion under the skin, reminiscent of a tumor.

The sizes can also vary, from unnoticeable to very voluminous, and depend on which organs have passed through the peritoneum. The hernia is mainly represented by the omentum and part of the intestine.

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This problem mainly affects women, especially during the postpartum period. This is explained by the fact that during pregnancy the muscles stretch and lose their elasticity. Men also experience femoral hernia, but four times less often than women.

Features of anatomy

If we consider the way pathology appears from the point of view of anatomy, then we can say that the inguinal ligament is separated from the pelvic bones by a certain space containing two lacunae. One of them is called vascular, because it includes the femoral artery and vein, and the other is called muscular, because. consists of the femoral nerve and the iliopsoas muscle.

The area between the femoral vein and the so-called lacunar ligament is filled with connective tissue and lymph node. It is this area that is called the femoral ring, through which the hernia subsequently “falls out.”

Moreover, the femoral canal does not form if the person is completely healthy. But as soon as there is a threat of a hernia, the canal makes itself felt.

Its dimensions are no more than 3 cm in length. When considering its structure, an external opening is distinguished, otherwise called the oval fossa, and an internal opening, called the femoral ring. The femoral canal also includes a vein, inguinal ligament with a wall and fascia lata.

At first, the protrusion is small in size. But as physical activity progresses, the insides trapped in the hernial sac begin to move further and can be brought out through the oval fossa and located near the femoral vein or in the space between the femoral artery and vein (this case is somewhat less common).

Causes

Any disease or pathology has its own causes. A femoral hernia is no exception. The main cause of this pathology is the weakening of the abdominal wall of the human body, which has a tissue-connective structure.

The following can also lead to problems: hip injury, for example, dislocation, excessive weight loss, or the formation of postoperative scars. In women, pathology mainly occurs due to repeated births. Moreover, the shorter the period between them, the greater the likelihood of getting a hernia.

The occurrence of a femoral hernia is possible due to problems with the intestines (namely, due to constipation), heavy lifting, severe coughing, physical activity, and problems with urination. All this leads to the development of pressure inside the abdominal cavity, which, in turn, leads to the formation of hernial protrusions.

Kinds

There are several types of femoral hernias:

If the patient is diagnosed with strangulation, then in this case we are talking about saving his life. When such a hernia forms, the entire contents of the hernial sac are compressed by the “gate.”

This leads to a disruption in blood circulation in the strangulated organs, which causes the development of necrosis, peritonitis and even intestinal gangrene.

Symptoms of a femoral hernia

Pathology can be detected by certain symptoms.

• With stages 1 and 2 of a femoral hernia, their protrusion is observed in the area of ​​the femoral-inguinal fold. Externally, such a protrusion is represented by a small tumor-like round formation, smooth to the touch.
• To externally determine the presence of a hernia, it is enough to compare the tumor with a photo. Pathology can be detected either during physical activity, coughing, straining, or while standing. When trying to reduce a hernia, rumbling sounds may be observed.
• If a hernia is formed by a protrusion of the intestinal area, this is accompanied by gas formation, as a result of which the patient’s abdomen becomes very swollen.
• The formation of a hernia can lead to swelling of the extremities due to compression of the femoral vein. In this case, numbness in the legs may occur.
• If the pathology is caused by the “prolapse” of the bladder, then in this case the patient will have a problem with emptying it. It can be painful, rare or frequent.
• Another aspect of the occurrence of protrusion is the likelihood of inflammation of a purulent or serous nature. As a rule, the inflammatory process begins with the protruding part of the hernia. But there are times when inflammation spreads to its outer layers.
• You can determine whether a hernia is inflamed or not by its characteristic symptoms. As a rule, inflammation is accompanied by hyperthermia, severe pain, peritonitis, as well as redness of the hernial sac or the surrounding area.
• A strangulated hernia can be determined by the accumulation of gases and feces with difficulty in removing them from the body, as well as severe pain. In this case, there is a thickening and increase in size of the hernia itself.
• If you do not seek help from a doctor, all this develops into necrosis and subsequently into intestinal obstruction. Also, nausea, hiccups, frequent vomiting, and cramping pain are observed.
• If you continue to postpone a visit to the doctor, the infringement leads to a drop in pressure, the occurrence of peritonitis, tension and bloating of the intestines, a rise in temperature, rapid heartbeat and even death.

Diagnostics

As for diagnosis, in the initial stages it is very difficult to recognize the occurrence of a femoral hernia due to the absence of pronounced symptoms.

For detection, auscultatory results are used, which are obtained during the detection of the presence of peristaltic noise; detection of a spherical protrusion in the area of ​​the femoral triangle when the patient is placed in a standing position; a method for determining tympanitis by percussion, a symptom of a cough impulse and the possibility of reducing a protrusion while lying down.

The hernial sac is also palpated, during which the doctor determines the reducibility of the protrusion, the contents of the hernia and its size.

During diagnosis, it is determined whether the tumor-like formation is indeed a femoral hernia, and whether it is not an inguinal hernia, metastases, lymphadenitis, thrombophlebitis, lipoma, aneurysm, edema abscess, etc.

To accurately determine the contents of the hernia, the patient is prescribed an ultrasound of the formation, pelvis, urinary tract and irrigoscopy.

Treatment

Unfortunately, the problem can only be eliminated surgically. As a rule, the patient is scheduled for elective surgery. But if the examination reveals an infringement, surgical intervention is performed immediately.

The operation is carried out in two ways:

The most popular, as well as safe, hernia repair according to Bassini is considered. Femoral hernia surgery is performed under general anesthesia. It can be either local or general.

The doctor’s actions during the operation can be described as follows:

1. First, the patient undergoes cutting of the hernial sac at the very bottom, followed by its dissection to the neck along the anterior surface.
2. Then they begin to separate the intestine and omentum from the walls of the hernial sac and resect its contents.
3. The separated entrails are placed in their place in the abdominal cavity.
4. If any obstructions are observed, the lacunar ligament is cut.
5. Next, the neck of the hernial sac is sutured from the upper side. In this case, a very strong synthetic thread is used, which is finally fixed with knots on both sides and cut.
6. The last step of the operation is cutting off the bag. If a sliding-type hernia operation is performed, then the neck is sutured internally using a purse-string suture. No punctures are made.

If the sutures between the groin and the external ligament are also applied using the Bassini method, then some rules are followed here as well. Only 2–4 stitches are applied, leaving a distance of 0.5 cm between them. All seams are secured with knots one at a time to prevent tugging of the veins.

As a rule, the first stitch is made at some distance from the vein. The next, second row of sutures (usually 3–4) are placed in the area between the falciform and pectineal fascia.

This approach makes it possible to strengthen the external opening in the femoral canal area. Afterwards, the wound is sutured in the usual way.

Stages

The formation of a femoral hernia occurs in three stages:

Regardless of the stages, a hernia may include several valves and a variety of contents.

Consequences

Basically, if the patient consults a doctor on time, a femoral hernia does not lead to complications. If time was lost, then there is the possibility of the formation of an irreducible protrusion with further consequences.

If the situation was extremely severe, then a femoral hernia can lead to subsequent intoxication of the entire body with further peritonitis and death.

If a strangulated femoral hernia is not treated in a timely manner, an inflammatory process may develop, as well as stagnation of feces.

When observing infringement of an internal organ, there is a possibility of developing its necrosis. In this case, the organ is removed.

Therefore, early and timely consultation with a doctor will help you not only get rid of the problem, but also preserve your health and even life.

The exit of the abdominal organs (intestinal loops, omentum) beyond its limits through the femoral canal is called a femoral hernia. The pathology occurs more often in women, in many cases it is asymptomatic. Complaints arise when complications develop, the most common of which is strangulation, and hernias of this location are prone to strangulation. Diagnosis is based on medical history, examination, and ultrasound. The treatment strategy for identifying the disease is surgical.

How is it formed

Between the inguinal ligament and the pelvic bones there is a space called the femoral triangle. It, in turn, is divided into two parts - muscular and vascular. The first contains the iliopsoas muscle and the femoral nerve, the second contains the femoral artery and vein. The vascular part, or lacuna, is the main site of pathology formation.

Normally, the vascular lacuna does not have free spaces and cracks, but under certain conditions, through its inner part - the femoral ring, under the skin of the anterior surface of the thigh, an intestinal loop or omentum emerges along with the peritoneum, forming the femoral canal. It is located almost vertically and has a length of within three centimeters. The oval fossa, located on the lata fascia of the thigh, is its external opening.

Reasons for formation

An imbalance between pressure in the abdominal cavity and the ability of the abdominal walls to resist it is the main reason for the development of hernial protrusion in the femoral triangle. This balance is disrupted in many conditions.

Kinds

Classification of hernial protrusions in the thigh area is carried out according to various criteria.

Clinical manifestations

In the initial stage, the hernia is often asymptomatic. In the incomplete stage, it may manifest as discomfort in the groin area or in the lower abdomen on the affected side. Unpleasant sensations usually intensify with varying physical activity.

A characteristic symptom of a complete hernia is a pathological tumor-like protrusion in the medial part of the upper third of the thigh, immediately under the inguinal ligament. Appearing in an upright position of the body and with straining, the formation can be easily reduced into the abdominal cavity.

When complications develop, the clinic depends on the contents of the hernial sac. If a loop of intestine is strangulated, and this is the most common option, then the following appear:

• tension and pain of the hernial protrusion;
• sharp local or diffuse abdominal pain;
• restless behavior;
• pale skin;
• weakness;
• nausea;
• repeated vomiting;
• retention of stool and gases.

Complications

In the absence of treatment, phlegmon (purulent melting) of the hernial sac may form: swelling, redness of the skin, severe pain, increased temperature, increased intoxication. Involvement of the peritoneum in the pathological process, perforation (violation of the integrity) of the distended section of the strangulated intestine lead to the development of peritonitis (inflammatory damage to the peritoneum). This condition threatens the patient's life and requires urgent surgical intervention.

Diagnostics

At the initial stage of formation, diagnosing a hernia of the described localization presents certain difficulties due to the virtual absence of complaints. When recognizing pathology, attention is paid to a small formation in the area of ​​the femoral-inguinal flexion, which appears in a vertical position. The survey and examination of the patient is supplemented with an ultrasound examination, if necessary, with a photo printout.

Femoral hernia in women is several times more common than femoral hernia in men. This is explained by the anatomical features of the female pelvis: it is wider. The consequence of this is a greater severity of lacunae, both muscular and vascular, and less strength of the inguinal ligament.

Differential diagnosis

Differential diagnosis is carried out with diseases that have similar symptoms.

Treatment

Conservative tactics are not used. If pathology is detected, surgical intervention is indicated - hernioplasty (elimination of hernial protrusion with plastic surgery of the defect). The operation presents certain difficulties due to:

• narrow lumen of the femoral canal;
• close location of the vein;
• atypical in many cases location of the obturator artery.

When performing the operation, the surgeon needs to excise the hernial sac as high as possible in order to eliminate the so-called peritoneal funnel, and then sew up the hernial orifice. Methods of surgical intervention are divided into two groups depending on access to the hernial orifice.

The rate of postoperative relapses is quite high. Therefore, either laparoscopic techniques or femoral canal prosthetics without tension on the stitched tissues using allomaterial, a synthetic material capable of implantation into body tissues, are now widely used. For this purpose, special polymer meshes are used.

If the hernial protrusion is strangulated and complications develop, it is necessary to resort to intra-abdominal surgical access. A midline laparotomy (an incision in the anterior abdominal wall) is performed with resection of a nonviable section of the intestine.

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