Q: A 78 year old male presented with a 6 week history of irreducible lump over

the medial aspect of the right groin, suspected to be an enlarged left groin
lymph node.

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 Femoral H.
Surgical Anatomy:
Femoral canal:
Occupies the most medial compartment
of the femoral sheath,

It is 1.25 * 1.25 cm

Contents: fat, lymphatic vessel & LN

Femoral canal bounded by:

1. anterior: Inguinal ligament
2. posterior: Ilio-pectineal lig., …..
3. lateral: Femoral vein
4. medial: Lacuner lig.

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– F : M is 2:1.
– Common in multipara women
– Easily missed on examination

– Emergency … in 50%
– U/S or CT-scan .

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 DDx.
1. An ing. H. : the neck of the sac the pubic tubercle …..

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 Q: What are the other differences between
Inguinal hernia & Femoral hernia?

Inguinal Hernia Femoral Hernia

More common in male
Pass through the inguinal
canal
Neck of the sac is above &
medial to the pubic tubercle
More common in female
Pass through the femoral
canal
Neck of the sac is below &
lateral to the pubic tubercle

Less common to be More common to be

strangulated strangulated
Can be treated surgically Must be treated surgically
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2. Saphena varix:
A sacular enlargement of the termination
of the long saphenous vein.

3. Psoas abscess:….
4. Enlarged Femoral LN:…..
6. Femoral aneurysm.
7. Lipoma.

Rx of F.H.:
By surgery ( risk of strangulation)…
open or laparoscopically, +/- mesh

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Q: A 60 year old obese woman presented with a history of
painful lump immediately above her umbilicus.

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 Umbilical H. & Para-umbilical H.

Ø Stretching of the linea alba reopening of the

umbilical defect. … Umbilical H.

Ø In adults, the defect is immediately adjacent to

(above) the true umbilicus…PUH

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Ø Even when very large, the neck
of the sac is narrow…….

Ø Umbilical H. contain bowel are

prone to become irreducible,
obstructed and strangulated.

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• Common in obese patients .
• Women > men.

Treatment:
• Operation should be advised ….
• Reduction of weight ( in obese patient) is essential before
operation.
• Surgery …Herniotomy +
Herniorraphy OR
Hernioplasty ( mesh ):
1. fascial defect > 4 cm
2. recurrent PUH 11/15
 Epigastric H.
• Occur through the linea alba anywhere between
xiphoid process & the umb. usually midway

• > one H. may present

C/F:
– Symptomless ( discover accidentally ).
– Local pain & tenderness to touch.

Rx:
– If the H. is symptomatic = operation.

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 Spigelian H.:
– They arise through a defect in the Spigelian fascia …

– Mostly appear below the level of the

umbilicus
– M = F , above 50 yrs

– O/E: soft, reducible mass ….

– Dx.: confirm by CT- scan or U/S.
– Rx. Surgery.

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 Parastomal h.
• The muscle defect created tends to increase in size over time …
• The rate is > 50 %.
• Difficult to manage a stoma..

• The stoma may be re-sited …

• Open suture and mesh techniques ..
• Prophylactic mesh insertion at the time of formation of the stoma.

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 Others external H.
vLumber H.:
vObturator H.:
vGluteal & Sciatic H:
v Perineal H.:
v Traumatic hernia:

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