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  • • Groin bulge inferior to the inguinal ligament elicited with the Valsalva maneuver

    • Differentiation between inguinal and femoral hernias difficult clinically and often not appreciated until the hernia sac is dissected free in the operating room

    • Femoral hernia protrudes through the femoral canal, bordered by the inguinal ligament superiorly, pubic ramus inferior-medially, and the femoral vein laterally

    • Classification of hernias

    • -Reducible: Visceral contents of the hernia sac able to retract into the abdominal cavity

      -Incarcerated: Visceral contents cannot be returned to the abdominal cavity

      -Strangulated: Incarcerated hernia where the blood flow to the entrapped viscera is compromised

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Epidemiology

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  • • 1.8:1 female predominance is seen with femoral hernia formation

    • Compared with inguinal hernias, femoral hernias more likely to present as incarcerated with or without strangulation

    • Femoral hernias are much less common than inguinal hernias

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Symptoms and Signs

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  • • Asymptomatic inguinal bulge most common symptom

    • Exam of the groin reveals a bulge inferior to the inguinal ligament that may extend onto the thigh

    • The hernia bulge may or may not be reducible

    • Patients may complain of a fullness or dragging sensation

    • As the hernia enlarges, it is likely to produce a sense of discomfort that may radiate onto the ipsilateral thigh or groin

    • Incarcerated (and especially strangulated) inguinal hernia bulge is exquisitely painful

    • Coughing or straining will help demonstrate small hernias

    • Small bowel obstruction symptoms (nausea, vomiting, abdominal distention) may be present with incarcerated femoral hernias

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Imaging Findings

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  • US: Although rarely needed, can verify the presence of a femoral hernia sac and reliably differentiate between a hernia and inguinal lymphadenopathy

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  • • Inguinal hernia

    • Hydrocele

    • Cord mass

    • Strained groin muscle

    • Epididymitis

    • Inguinal lymphadenopathy

    • Varicocele

    • Undescended testes

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Rule Out

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  • • Strained groin muscle (chronic groin pain commonly develops in these following operative intervention)

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  • • Physical exam usually all that is required to accurately diagnose inguinal hernia

    • In equivocal cases, US may be helpful

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When to Admit

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  • • Acute hernia incarceration

    • Clinical evidence of strangulation

    • Associated small bowel obstruction

    • Uncomplicated femoral hernia management can be performed as an outpatient

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  • • Femoral hernias should be surgically repaired unless there are specific contraindications

    • Several successful repairs available including native tissue or prosthetic mesh repair

    • Femoral hernia repair may be performed via upper thigh incision or with a standard transverse inguinal incision

    • Both open and laparoscopic repairs are commonly used

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Surgery

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Indications

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  • • Immediate repair in the case of incarcerated or strangulated femoral hernia repair

    • Uncomplicated femoral hernias can be repaired electively as an outpatient

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Treatment Monitoring

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  • • Physical exam to detect wound/prosthetic infection or hernia ...

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