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FEMORAL_SHEATH_AND_FEMORAL_HERNIA(2).pdf
- 1. FEMORAL SHEATH AND FEMORALHERNIA Presened by : D.Bhuvanesh Roll no : 63.
- 2. OBJECTIVES : Introduction Formation offemoral sheath Gross anatomy Structures piercing femoral sheath Relation with saphenous opening Femoral hernia
- 3. Introduction Femoral sheath isa funnel shaped fibro areolar structure that wraps around the proximal part of femoral vessels in the upper part of thigh. It is an funnel shaped sleeve of fascia enclosing tunica adventitia of femoral vessels about 3 to 4 cm below the inguinal ligament. Femoral vessels are in the femoral sheath as they pass through femoral triangle.
- 6. Formation of femoralsheath Anterior wall : formed by fascia transversalis (fascia covering transverse abdominis muscle) Posterior wall : formed by iliopsoas fascia (fascia covering iliacus muscle and psoas major muscle)
- 7. Lateral wall offemoral sheath is vertical and directed downward. Medial wall of femoral sheath is oblique and directed downward and laterally.
- 8. Gross anatomy 1. 2. 3. Anterior andposterior walls are interconnected by two partitions(called as antero posterior septa) thus creating three compartments. Lateral compartment : femoral artery and femoral branch of genito femoral nerve Intermediate compartment : contain femoral vein Medial compartment ( femoral canal )
- 10. Medial compartment orfemoral canal • • • It is also called as femoral canal It is conical shaped and about 1.25 cm long Its base is directed above and forms an oval shaped femoral ring It is an potential or dead space allows expansion of femoral vein during increased venous return CONTENTS : Lymph node of cloquet or Rosenmuller lymph node – drains Glans penis in males Clitoris in females Lymphatic vessels Small amount of areolar tissue
- 14. Femoral ring • • • • Proximal endof the femoral canal is called femoral ring. It is an area of connection between abdominal cavity and femoral canal. BOUNDARIES Anterior : Inguinal ligament Posterior : pectineus muscle and its covering fascia Medial : Crescentic edge of lacunar ligament Lateral : Septum separating it from femoral vein
- 15. Femoral ring isclosed by femoral septum which is formed by condensation of extra peritoneal tissue. Peritoneal septum shows a depression above known as femoral fossa.
- 16. Structures piercing femoralsheath Anterior : Superficial epigastric artery , superficial circumflex iliac artery , superficial external pudendal artery Medial : Great saphenous vein Lateral : femoral branch of genito femoral nerve
- 17. Relationship with saphenousopening Medial portion of femoral sheath lies behind the saphenous opening. Lateral portion of femoral sheath lies behind the fascia lata. Falciform margin of saphenous opening lies infront of femoral sheath. Medial ill defined margin of saphenous opening passes behind the femoral sheath. Cribriform fascia covers antero medial surface of femoral sheath.
- 19. Function of femoralsheath Allows the femoral vessels to glide freely in and out beneath the inguinal ligament during movements of hip joint.
- 20.
- 21. WHAT IS HERNIA? ABNORMAL PROTRUSION OF A VISCUS OR PART OF VISCUS THROUGH NORMAL OR ABNORMAL OPENING FROM ITS WALL CONTAINING CAVITY
- 22.
- 23. In a femoralhernia part of the small intestine protrudes through the femoral ring into femoral canal. It presents as a lump situated inferolaterally to pubic tubercle. Neck of sac is below and lateral the pubic tubercle.
- 24. Inferolateral position offemoral hernia
- 25. • • • Femoral hernia ismore common in females than men because Wider femoral ring Wider pelvis Small size of femoral vessels
- 26. Covering of femoralhernia From inside to outside Peritoneum of hernial sac Femoral septum Anterior wall of femoral sheath Cribriform fascia Superficial fascia and skin
- 28. Course of femoralhernia A section of intestine bulge through the ring Pushes out a hernial sac of peritoneum covered by femoral septum Bulges downward through the femoral ring in to the femoral canal Pushes forward through the saphenous opening Finally turns upward around upper falciform margin of saphenous opening towards inguinal ligament
- 31. ETIOLOGY(study of causation) Widefemoral canal Increased abdominal pressure Natural weakening of tissue More commonly seen in multiparous women Being over weight Over straining while coughing
- 32. Strangulation of femoralhernia More common to obstruction and strangulated. Boundaries of femoral ring are rigid and the medial margin of lacunar ligament is sharp. This sharpness can cut through the tissue or impede the blood vessel. Then the blood supply to the intestinal contents reduces then results in ischemia leads to death.
- 33. Treatment In case ofstrangulation surgeon have to wide femoral ring. Widening is possible only by cutting through the sharp concave border of lacunar ligament. Normally obturator artery is away from lacunar ligament so cutting lacunar ligament is not danger. BUT IN RARE CASES aberrant or abnormal obturator artery lie at edge of lacunar ligament and cutting it during hernial repair cause extensive bleeding(hemorrhage).
- 35. Repair of hernia Normally if abdominal content not passed through neck into body of sac it can be pushed back in opposite direction to its course.
- 36. BIBILIOGRAPHY Essentials of humananatomy – By Dr.A.K.Dutta. Inderbir singh textbook of anatomy. B.D.Chaurasia’s Human anatomy. Netter atlas of anatomy.
- 37. SPREAD GRATITUDE NOTCORONA THANK YOU