c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Hernia Technique Master Class: 70

A D V E R T I S E M E N T

   

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The lower end of the femoral canal is shown.     

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Hernia Technique Master Class: 71

A D V E R T I S E M E N T

   

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In about a quarter of individuals, the obturator artery arises from the inferior epigastric rather than the internal iliac. When it is aberrant in this way, it runs around the neck of the upper end of the femoral canal. It can be damaged during open, laparoscopic and femoral hernia repairs, causing bleeding into the preperitoneal space and significant loss of blood. Sudden drop in hematocrit in an elderly vasculopath could be lethal, thus the surgical moniker “corona mortis/crown of death”.   

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Hernia Technique Master Class: 72

A D V E R T I S E M E N T

   
 

Femoral hernia is more common in women than men, especially thin elderly women (inguinal hernia is still more common in women than femoral). Partial incarceration of the wall of the bowel (Richter’s hernia) may not cause obstructive symptoms before the strangulated knuckle of bowel perforates, retracts into the abdomen and causes peritonitis. The fascia lata of the thigh directs the bulge up over the inguinal ligament, making differentiation from an inguinal hernia difficult. If the bulge is more below a line drawn between ASS and pubic tubercle, it is likely to be a femoral hernia. If closed reduction of an incarcerated femoral hernia is attempted, the patient should be observed for signs of compromised bowel in house and repaired on the same admission.    

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This page was last modified on 2/10/2009.