The great importance of the femoral canal is, of course, that it is a potential point of weakness in the abdominal wall through which may develop a femoral hernia. Unlike the indirect inguinal hernia, this is never due to a
Sac femoral hen
Sac femoral hen
congenital sac and, although cases do occur rarely in children, it is never found in the newborn.
As the hernia sac enlarges, it emerges through the saphenous opening then turns upwards along the pathway presented by the superficial epigastric and superficial circumflex iliac vessels so that it may come to project above the inguinal ligament. There should not, however, be any difficulty in differentiating between an irreducible femoral and inguinal hernia; the neck of the former must always lie below and lateral to the pubic tubercle whereas the sac of the latter extends above and medial to this landmark
The neck of the femoral canal is narrow and bears a particular sharp medial border; for this reason, irreducibility and strangulation occur more commonly at this site than at any other. In order to enlarge the opening of the canal at operation on a strangulated case, this sharp edge of Gimbernat's lacunar ligament may require incision; there is a slight risk of damage to the abnormal obturator artery in this manoeuvre and it is safer to enlarge the opening by making several small nicks into the ligament. The safe alternative is to divide the inguinal ligament, which can then be repaired.
Note. Normally there is an anastomosis between the pubic branch of the inferior epigastric artery and the pubic branch of the obturator artery. Occasionally the obturator artery is entirely replaced by this branch from the inferior epigastric—the abnormal obturator artery. This aberrant vessel
usually passes laterally to the femoral canal and is out of harm's way; more rarely, it passes behind Gimbernat's ligament and it is then in surgical danger.
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