Femoral hernia – tumorous education which is formed at an exit of loops of an epiploon and intestines out of limits of an abdominal cavity through a femoral ring. Femoral hernia is shown by existence of a tumor, pain.
Femoral occurs among total number of hernias of a stomach approximately in 5-8% of cases. Are more subject to development of femoral hernia of the woman. At men femoral hernia develops four times less often. It is connected with anatomic features of a body. Sometimes, that the disease develops at small children of the first year of life in connection with physiological weakness of fabrics of an abdominal wall.
Weakening of an abdominal wall is the main reason of femoral hernia. In turn, often lead the following factors to weakening of an abdominal wall: injuries of an abdominal wall, post-operational hems, hip dislocations, disturbance of an innervation of an abdominal wall. Development of femoral hernia in men is promoted by excessive exercise stresses, and to development of femoral hernia in women – numerous pregnancies and long childbirth.
Often lead the situations connected with continuous increase in intra belly pressure to developing of a disease: the complicated urination, physical effort, a constant severe cough, locks, etc. And, developing of hernia can develop even after single rise in weight, or develop against the background of long cough (for example, at chronic bronchitis).
Femoral hernias in the location divide on bilateral and unilateral. According to clinic allocate the unreducible, reducible and restrained femoral hernias.
Unreducible hernias or are set not completely, or at all do not give in to reposition in an abdominal cavity. The restrained femoral hernias are characterized by a hernia contents prelum hernial gate that is very dangerous as there is a probability of acute intestinal impassability, peritonitis, gangrene of a gut or necrosis.
Process of formation of femoral hernia has three stages:
At the first and second stage the disease is characterized by hernial protrusion in an inguinofemoral fold. The tumor, as a rule, has the small sizes, rounded shape and a smooth surface. Especially it is noticeable in vertical position or at a tension. After reposition disappears with the characteristic humming sound.
In the presence in hernial looping of intestines the tympanites is defined. In the presence of femoral hernia there can sometimes be a hypostasis of the lower extremity caused by a prelum of a femoral vein and which is followed by numbness and feeling of "goosebumps on a body". If the bladder gets to a hernial bag, dysuric frustration can develop.
Its inflammation belongs to complications of femoral hernia. The inflammation can be both purulent, and serous. First of all there is a hernia contents inflammation (a gut, an appendix, uterus appendages, etc.). The inflammation can sometimes pass to a hernial bag from integuments. The inflamed hernia causes a feeling of pain, a dermahemia, the increased body temperature. Development of peritonitis is in certain cases possible.
The restrained femoral hernia is fraught with development of an innervation of the bodies which are in hernia or an acute disorder of blood circulation. These symptoms are followed by increase in hernia in sizes and its consolidation. There are severe pains in a stomach, the delay of gases and a chair develops. This state can result in intestinal impassability and a necrosis, shown in nausea, colicy pains, a hiccups, repeated vomiting.
At initial stages it is quite difficult to diagnose a disease as there are no pronounced symptoms. As a rule, diagnose femoral hernia after manifestation of typical symptomatology (characteristic protrusion in the field of a femoral triangle, a symptom of a tussive push, a vpravlyaemost in horizontal position, etc.).
At a palpation of hernial education it is possible to define character of its contents, degree of a vpravlyaemost of hernia and to specify the sizes of the hernial channel. In the course of diagnosis femoral hernia needs to be differentiated from congestive abscess, inguinal hernia, a varicosity, a lipoma, thrombophlebitis, metastasises of cancer tumors, etc.
Ultrasonography and irrigoskopiya helps to define contents of a hernial bag.
Conservative treatment of femoral hernia is impossible therefore in the presence of a disease only an operative measure is shown. The most widespread method of an operative measure – a hernioplasty (herniotomy with defect plastics).
Operation for treatment of femoral hernia assumes opening of a bag with contents of hernia and its careful survey, and if necessary – removal of an epiploon and reposition of contents of hernia in an abdominal cavity. Further bandaging, excision of a hernial bag and plastic of the hernial channel follows. The hernioplasty is carried out as using synthetic materials, and own tissues of the patient.
At the restrained femoral hernia often carry out a median laparotomy with removal of the impractical site of intestines.
In most cases the forecast at treatment of femoral hernia favorable, patients can return to usual life.
The most high temperature of a body was recorded at Uilli Jones (USA) who came to hospital with a temperature of 46,5 °C.
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