Femoral hernia
Introduction
Introduction to the stock market Femoral hernia (femoral hernia) refers to the organ or tissue through the femoral ring into the femoral canal, and then through the femoral tube to protrude the fossa of the fossa ovalis, that is, the hernia sac through the femoral ring, through the femoral canal to the fossa ovalis. Femoral hernia is the lowest incidence of sputum in the inguinal region, accounting for 3% to 5% of abdominal hernia. Because the femoral hernia has a fairly high incidence of incarceration/stretching and bowel resection, delayed treatment will increase mortality, especially in elderly patients, so surgical treatment is the only effective method for femoral hernia. basic knowledge The proportion of illness: 0.005% Susceptible people: more common in women over 40 years old Mode of infection: non-infectious Complications: intestinal fistula abscess
Cause
Cause of femoral hernia
Physiological and anatomical basis (35%):
The femoral hernia is more common in middle-aged women, which is closely related to its physiological and anatomical basis. The femoral ring is the upper mouth of the femoral tube, which is only covered with loose connective tissue; the femoral tube is a conical blind tube, with a considerable part of the front The wall is seen in the saphenous vein hole. The superficial structure is the fascia fascia, no muscle protection; the inguinal hernia is narrow, away from the pubic ligament; the female pelvis is wider, the ligament muscles, blood vessels are thinner than the male, so the femoral ring Significantly larger than men, is considered to be one of the main reasons for the prevalence of stocks.
Changes in the thickness of the external iliac vein (15%):
In addition, changes in the thickness of the external iliac vein can also have a direct effect on the opening of the femoral ring, especially in the middle and late stages of uterine compression, resulting in thickening of the blood vessels caused by external venous and femoral venous return disorders, the release of vascular compression after delivery, and the caliber Fine, will obviously affect the size of the femoral ring and its adjacent gaps, pregnancy can cause abdominal muscles to stretch, ligament relaxation, due to the special anatomical features of the femoral ring, these structures are weaker, any increase in intra-abdominal pressure Factors such as bloating, constipation, bronchitis, cirrhosis, ascites and other diseases, as well as age, chronic wasting disease, muscle atrophy or degeneration can induce femoral hernia.
Inguinal hernia repair (15%):
In addition, the incidence of femoral hernia may be related to inguinal hernia repair surgery, according to Glassow (1970), more than 25% of patients with femoral hernia have a history of inguinal hernia repair, because the traditional inguinal hernia repair with inguinal ligament, the ligament is pulled As mentioned above, the tension suture repair caused the opening of the femoral ring to open, which opened the door for convenience.
(two) pathogenesis
In the process of the development of the femoral hernia, the extraperitoneal fat is often prominent, playing the role of opener, followed by peritoneal protrusion, followed by intestinal tube or omentum to form a femoral hernia, because the femoral tube is vertically downward Therefore, the direction of the development of the femoral hernia is that the contents fall linearly, and before the turning to the upper edge of the saphenous vein, an acute angle is formed, and the root of the femoral sac is raised. The covering structure of the hernia sac includes: skin, superficial fascia, sieve tendon The membrane, the anterior wall of the femoral sheath and the extraperitoneal tissue, unlike other iliac crests in the groin area, have few protective factors in the femoral ring. In addition to the inguinal hernia attached to the pubic ligament, the abdomen transverse fascia lacks protection. This is because the transverse fascia has been involved in the formation of the femoral sheath. Once the femoral condyle pushes the inguinal hernia into the femoral canal, the sac neck will be embedded by the ligament of the sac, the inguinal ligament, the pubic ligament and the femoral sheath. In the enclosed ring (ankle ring), the above structure is tough and lacks stretchability, so that it is easy to cause incarceration of the strands and strangulation.
According to the position of the hernia sac, the femoral hernia is divided into 6 types:
1 typical femoral hernia;
2 prevascular hernia;
3 foreign share (exfemoral hernia);
4 femoral hernia of pectineal ligament;
5 pubic bones (pectineal hernia);
6 retrovascular hernia.
Prevention
Femoral hernia prevention
First, we must have confidence, patience, meticulousness, carefulness, and always maintain optimism and pleasant mood. This is of great benefit to the maintenance of suffocating.
Second, the initial development of hernia, should be given enough attention, need to be properly and effectively maintained, with daily walking, activities, the formation of habitual fall, once stuck in the ring mouth, can not be reset, will cause intestinal necrosis, to prevent micro-duration.
Third, adhere to appropriate, appropriate, timely exercise, enhance physical fitness, improve disease resistance, do not do violent activities such as squatting, jumping, squatting, pulling, holding weight, this is very unfavorable for the normal maintenance of suffocation.
Fourth, pay attention to diet conditioning, food should be warm, cooked, soft, eat raw, cold, hard food, take less meals, prevent over-satisfaction, choose foods that are nutritious, easy to digest and absorb, to reduce the burden on the stomach, also It is to relieve the pressure on the carcass.
Fifth, to prevent constipation, to keep the stool smooth, is the key to prevent sputum, sputum, the elderly abdominal wall is weak, due to constipation, defecation force, increase abdominal pressure, promote the corpus callosum, this is difficult to grasp the normal maintenance of suffocation.
Complication
Femoral complications Complications intestinal fistula abscess
Intestinal necrosis and intestinal fistula are serious complications of incarceration of the femoral hernia. After incarceration of the femoral hernia, if the strangulation occurs, the contents of the tendon are necrotic, then there is a purulent lymphadenitis or other abscess-like changes. Once the incision is made, the intestine is caused. Hey.
Symptom
Symptoms of femoral hernia Symptoms Common symptoms Responsive dullness Blood supply disorders Ascites Abdominal pain Constipation Pain in the inner thighs Soft tissue infections Varicose cysts
The femoral hernia is mainly characterized by a hemispherical bulge under the inguinal ligament (ie, the thigh root), usually like the size of an egg, with few goose eggs. The texture is soft, and the sputum can not completely disappear after lying down. When the cough increases the abdominal pressure, the local impact is not obvious. Some patients can feel the pain and fall discomfort after standing for a long time. Due to the lack of typical clinical manifestations of this disease, easy misdiagnosis and missed diagnosis is also one of the clinical features of this disease. Asymptomatic patients, especially obese patients, are easily overlooked and can only be seen when complications such as incarceration or strangulation occur.
Examine
Stock inspection
1. The re-recoverable femoral examination project is based on the inspection box "A";
2. Invasive femoral hernias with mechanical intestinal obstruction or severe illness, the examination project may include inspection of the frame limits "A" and "B";
3. When the diagnosis is unclear or needs to be identified with other diseases, the inspection project may include the inspection of the limits "A", "B".
Diagnosis
Femoral diagnosis
diagnosis
The diagnosis of femoral hernia is mainly based on clinical manifestations. Through detailed clinical examinations and necessary auxiliary examinations such as ultrasonography, the diagnosis of femoral hernia can be clarified. Diagnosis is to avoid the following mistakes: in the examination of the patient's perineal exposure incomplete detection of the inguinal region; only pay attention to the typical acute intestinal obstruction, so that the incarceration is misdiagnosed as intestinal obstruction; if the inguinal hernia is large, may pass The stock tube becomes a compound femoral hernia. Usually, only the repair of the straight sputum is missed during the operation and the femoral hernia is missed, resulting in a relapse in the short term after surgery, which is actually missing .
Differential diagnosis
The diagnosis of femoral hernia is sometimes not easy, especially in the following diseases:
1. Inguinal hernia: The inguinal hernia is located in the upper part of the inguinal ligament, and the femoral hernia is located in the lower part of the inguinal ligament. It is generally not difficult to differentiate diagnosis. It should be noted that a larger portion of the femoral condyle except for a portion of the ankle block is located below the inguinal ligament and a portion may extend subcutaneously over the inguinal ligament. Using a finger to probe whether the outer ring is enlarged helps to identify the two.
2. Lipoma: There is often a thick layer of adipose tissue outside the femoral sac. After the sputum contents are returned, the local lumps may not completely disappear. This adipose tissue has the potential to be mistaken for lipoma. The difference between the two is that the base of the lipoma is not fixed, the activity is large, and the base of the femoral condyle is fixed and cannot be pushed.
3. swollen lymph nodes: incarcerated femoral hernia is often misdiagnosed as inguinal lymphadenitis.
4. Large saphenous vein varices nodules: The saphenous veins at the fossa ovalis enlargement when standing or coughing, disappearing when lying down, may be misdiagnosed as easy-recovery femoral hernia. Compression of the proximal end of the femoral vein can increase the nodular enlargement; in addition, other parts of the lower extremity with varicose veins are important for differential diagnosis.
5. Lumbral tuberculous abscess: cold abscess caused by spinal or ankle tuberculosis can flow along the psoas muscle to the groin area and manifest as a lump. This lumps can also have a coughing impact, and can be temporarily reduced when lying down, which can be confused with the femoral hernia. Careful examination revealed that the abscess was located in the lateral part of the groin, at the eccentric axilla, and was fluctuating. Checking the spine often reveals signs of lumbar vertebrae.
