Femoral hernia pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
Pathophysiology
Anatomy
- Pelvicrural interval, an opening from the abdomen to the thigh is divided in to two spaces:[1]
- Lacuna musculosa (lateral space), as the name suggests the iliopsoas muscles pass through this space.
- Lacuna vasculosa (medial space), as the name suggests this is the passage for the femoral vessels.
- In the pelvis along the anterior surface of the iliopsoas muscle run the external iliac vessels.[2]
- The external iliac vessels pass between the iliopubic tract and Cooper's ligament and then under the inguinal ligament to become the femoral vessels.[2]
- As the external iliac vessels pass along the lacuna vasculosa they are covered by the transversalis fascia forming the femoral sheath.[2]
- The femoral sheath extends 4cm caudally to become the adventitia of the femoral vessels.[2]
- The femoral sheath has a medial compartment that is known as the femoral canal.[2]
- The femoral canal is less than 2 cm in diameter and it contains lymphatics and glands.[2]
- The true opening of the femoral canal is a musculoaponeurotic ring that consists of:[3]
- Cooper's ligament inferiorly
- Femoral vein laterally
- Iliopubic tract superiorly and medially
- The medial boundary of the femoral ring is made up of the lateral edge of the aponeurosis of the insertion of the transversus abdominus muscle with the transversals fascia onto the pubis.[3]
- The true inner ring of the femoral canal is bounded:[4]
- Anteriorly and medially by the iliopubic tract.
- Posteriorly by the Cooper's ligament.
- The distal orifice (neck of the femoral canal) of the femoral canal has a rigid boundary which is usually less than 1cm in diameter and is surrounded by:[5][6]
- The lacunar ligament medially
- The inguinal ligament anteriorly
- Fascia of the pectineal muscle posteriorly
- The rigidity of these structures is the reason for strangulation in femoral hernias.
Pathogenesis
- A femoral hernia is the protrusion of the peritoneal sac through the femoral ring in to the femoral canal posterior and inferior to the inguinal ligament and it is medial to the femoral vessels.[7]
- The hernia sac can contain preperitoneal fat, omentum or small bowel.
- Femoral hernias typically have a narrow neck, which predisposes them to incarceration and the need for emergent surgery.
- De Garengeot hernia is a type of femoral hernia that contains the appendix.[8]
- Littre hernia is an uncommon type of femoral hernia that contain a Meckel's diverticulum.[8]
Genetics
- [Disease name] is transmitted in [mode of genetic transmission] pattern.
- Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].
- The development of [disease name] is the result of multiple genetic mutations.
Associated Conditions
Gross Pathology
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Microscopic Pathology
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
References
- ↑ Panton JA (1923). "Factors bearing upon the Etiology of Femoral Hernia". J. Anat. 57 (Pt 2): 106–46. PMC 1262989. PMID 17103962.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Lichtenstein, Irving (1986). Hernia repair without disability : a surgical atlas illustrating the anatomy, technique, and physiologic rationale of the "one day" hernia and introducing new concepts : tension-free herniorrhapies. St. Louis: Ishiyaku EuroAmerica. ISBN 0912791306.
- ↑ 3.0 3.1 McVay CB (1974). "The anatomic basis for inguinal and femoral hernioplasty". Surg Gynecol Obstet. 139 (6): 931–45. PMID 4278445.
- ↑ MCVAY CB (1965). "INGUINAL AND FEMORAL HERNIOPLASTY". Surgery. 57: 615–25. PMID 14275790.
- ↑ Lytle WJ (1974). "The inguinal and lacunar ligaments". J. Anat. 118 (Pt 2): 241–51. PMC 1231505. PMID 4280996.
- ↑ Papanikitas J, Sutcliffe RP, Rohatgi A, Atkinson S (2008). "Bilateral retrovascular femoral hernia". Ann R Coll Surg Engl. 90 (5): 423–4. doi:10.1308/003588408X301235. PMC 2645754. PMID 18634743.
- ↑ Doherty, Gerard (2010). Current diagnosis & treatment : surgery. New York: Lange Medical Books/McGraw-Hill. ISBN 978-0071635158.
- ↑ 8.0 8.1 Phillips AW, Aspinall SR (2012). "Appendicitis and Meckel's diverticulum in a femoral hernia: simultaneous De Garengeot and Littre's hernia". Hernia. 16 (6): 727–9. doi:10.1007/s10029-011-0812-2. PMID 21442431.