This document discusses a case of a 65-year-old woman presenting with abdominal pain and vomiting. Upon examination, she was found to have a swollen region in her right thigh. Based on her history and symptoms of colicky abdominal pain referred to the umbilicus, investigations revealed an intestinal obstruction due to a femoral hernia in the thigh. Left untreated, strangulated hernias can lead to tissue necrosis and life-threatening complications. The femoral ring's unyielding nature can cause hernia strangulation as it is unable to expand under pressure.

1. ECE – 5
CLINICAL IMPORTANCE
OF FEMORAL CANAL
DR. MUKESH FULWARIA

2. CASE

3. CASE
A 65-year-old woman visited the
emergency department of a hospital and
complained of abdominal pain and
repeated vomiting.

4. SYMPTOMS
On questioning,
The patient told that the pain was severe
and colicky in nature and most severe in
the region of umbilicus.

5. SIGNS
On examination,
The abdomen was distended and
excessive loud bowel sound could be
heard with the stethoscope.
A small lemon-sized swelling was also
noticed on the upper medial aspect of
the right thigh.
The swelling was located infero-lateral
to the pubic tubercle.

6. CASE - HISTORY
The patient told she is having this
swelling for the last 3 or 4 months.

7. DISCUSSION

8. DISCUSSION
The word "colic" is derived from the ancient
Greek word for intestine.
A colic pain in adults may feel like a dull ache,
a cramp or a sharp pain and occurs usually
after a large meal or around bedtime.
Colic pain that starts and stops abruptly.
Associated by sweating and vomiting.

9. DISCUSSION
Colic occurs when there is an obstruction
within a hollow internal body part (small and
large intestine, gall bladder, ureter, etc.), such
as the intestines, gallbladder, rectum, kidneys,
or ureters.
It occurs due to muscular contractions of a
hollow tube in an attempt to relieve an
obstruction by forcing content out. It may be
accompanied by sweating and vomiting.

10. Reason for referred pain to the umbilicus –
The sympathetic supply is derived from T10–
T11 spinal segments through splanchnic
nerves and superior mesenteric plexus. For
this reason, pain from the jejunum and ileum
is referred to the umbilical region.
Reason for referred pain are Acute intestinal
obstruction, appendicitis(Rt. side), hernia etc.
DISCUSSION

11. INVESTIGATION
Abdominal USG or ultrasound,
CT scan or
MRI.

12. DIAGNOSIS

13. DIFFERENTIAL DIAGNOSIS
Femoral hernia
Inguinal hernia,
Acute intestinal obstruction,
Hydrocele/varicocele,
Lymphadenopathy,
Lipoma,
Cyst,
Abscess,
Hematoma, and
Femoral artery aneurysm.

14. A diagnosis of “acute intestinal
obstruction secondary to the femoral
hernia”.
FINAL DIAGNOSIS

15. EXPLANATION

16. Questions 1.
Q. Name the hernia which is located
below and lateral to the pubic tubercle.
Name the passage through which the
hernia has entered into the thigh.

17. EXPLANATION
Femoral
hernia.
Femoral ring
and
femoral canal.

18. Questions 2.
Q. What is the cause of strangulation of
femoral hernia?

19. Unyielding
nature (unable
to bend or be
penetrated
under pressure;
hard) of the
femoral ring.
EXPLANATION

20. Questions 3.
Q. What are the boundaries of femoral
ring?

21. Anterior: Inguinal ligament
Medial: Sharp edge of the lacunar ligament
Posterior: Pecten pubis
Lateral: Femoral vein
EXPLANATION

22. Questions 4.
Q. What is the direction of femoral hernia
and its importance to the surgeon?

23. The direction of femoral
hernia is downward,
forward, and upward.
During manual reduction
of femoral hernia, the
surgeon reverses the
order by pushing the
hernia downward,
backward, and upward.
EXPLANATION

24. Questions 5.
Q. Give the cause of intestinal obstruction.

25. Venous congestion followed by an
arterial occlusion of the intestinal loop
due to strangulation of hernia.
EXPLANATION

26. Questions 6.
Q. Give the anatomical basis of pain in
the umbilical region.

27. A loop of the small intestine was pushed
into the hernial sac and pain from the
small intestine was referred in the region
of umbilicus (supplied by T10–T11 spinal
segments).
EXPLANATION

28. Q. Complications due to lack of treatment
in case of strangulated hernia?
Questions 7.

29. EXPLANATION
Most complications with strangulated hernias
occur because of lack of treatment.
The tissue that has been cut off from the
blood supply can cause necrosis. This leads to
a potentially life-threatening situation.

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DR. MUKESH FULWARIA
BDS, PGDE (Endodontics)
MSc.(Med.) Anatomy