View Full Version : STRANGULATED FEMORAL HERNIA(Etiology-Pathology-Clinical picture-Complications-Treatment)

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06-08-2008, 08:26 AM
Ä Cause of strangulation is pressure by the sharp margin of the lacunar ligament.
Ä Pathology. The changes which occur are similar to those occurring with a strangulated inguinal hernia.
Two items should be considered:
1. The hernia may be of the Richter's type and strangulation may occur without evidence of obstruction.
2. As the hernia is a small one it may be missed, especially in a fatty patient, until it bursts and leads to faecal peritonitis.
Ä Clinical features: These are similar to the features of strangulated inguinal hernia (general, abdominal and local). However in the Richter's type obstruction may not be evident and unless careful examination is done the diagnosis may be lost.
ÄOf strangulated femoral H.:
a- From strangulated inguinal H.
b- Iliopsoas bursae or lipoma.
c- Inguinal adenitis or abscess.
Ä Treatment: The treatment is on the same principles. The inguinal approach is performed. The lower skin flap is at first dissected downwards and the fundus of the sac is opened to evacuate the infected fluid. The lacunar ligamnet is stretched or divided to relieve the strangulation. Sometimes it may be advantageous to divide the medial attachment of the inguinal ligament to gain space (Astley Cooper's method). The ligament is stitched again after dealing with the strangulated content.
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