Neck of the sac of femoral hernia lies
Correct Answer: Below and lateral to pubic tubercle
Description: Ans. b (Below and lateral to pubic tubercle) (Ref. Bailey and Love 25lh/pg. 971).FEMORAL HERNIA# A femoral hernia occurs through the femoral canal that is bounded superiorly by the iliopubic tract, inferiorly by Cooper's ligament, laterally by the femoral vein, and medially by the junction of the iliopubic tract and Cooper's ligament (lacunar ligament).# A femoral hernia produces a mass or bulge below the inguinal ligament.# Femoral hernias are difficult to diagnose clinically because of their deep location in the femoral canal.- Laugier's is through the gap in the lacunar (Gimbemat's) ligament.- Narath's occurs only in patients with CDH and is due to lateral displacement of psoas muscle.# Account for 1% of all abdominal wall hernia# Female: male ratio is 4:1# Commonest in middle-aged and elderly women, more common in parous# Rare in children# Much less common than inguinal hernias but are as common as inguinal hernias in older women# They always remain below the inguinal ligament and lateral to the pebic tubercle and are more prone to incarceration and strangulation than inguinal hernias.# This type of hernia occurs more commonly in females and usually contains preperitoneal fat, omentum, and/or small bowel.# Clinically, saphena varix is its closest DD.Femoral hernia : Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle.More common in women.Direct inguinal hernia: Protrudes through the internal (Hesselbach's) triangle. Bulges directly through abdominal wall medial to inferior epigastric artery. Goes through the external (superficial) inguinal ring only. Covered by transversalis fascia. Usually in older men.Indirect inguinal hernia: Goes through the INternal (deep) inguinal ring, external (superficial) inguinal ring, and Into the scrotum. Enters internal inguinal ring lateral to inferior epigastric artery. Occur in Infants owing to failure of processus vaginalis to close. Much more common in males.Management:# All uncomplicated femoral hernias should be repaired as an urgent elective procedure- A femoral hernia can be repaired using:# The standard Cooper's ligament repair,# A preperitoneal approach, or# A laparoscopic approach.# Three classical approaches to the femoral canal have been described:- Low (Lockwood).- Transinguinal (Lotheissen)- High (McEvedy)# Irrespective of approach used the following will be achieved:- Dissection of the sac- Reduction/inspection of the contents- Ligation of the sac- Approximation of the inguinal and pectineal ligaments
Category:
Surgery
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