Femoral hernia

Femoral hernias occur when a section of the bowel or any other part of the abdominal viscera pass into the femoral canal. The canal is usually a densely packed area of the anterior thigh, however, it is a potential space that can become occupied by herniated contents via the femoral ring.

Features:

• A lump within the groin, that is usually mildly painful;
• It is important to distinguish femoral hernias, which are inferolateral to the pubic tubercle, from inguinal hernias which are supermedial to the pubic tubercle;
• Typically non-reducible, although can be reducible in a minority of cases;
• Given the small size of the femoral ring, a cough impulse is often absent.

Epidemiology

• Much less common than inguinal hernias (only 5% of abdominal hernias are femoral)
• More common in women (M:F 1:3)
  • The effects of increased abdominal pressure in pregnancy measn that femoral hernias are more common in multiparous women compared to nulliparous women.

Diagnosis is usually clinical, although ultrasound is an option. As with any lump, wherever it may be located, there are important differentials to exclude for femoral hernias:

• Lymphadenopathy
• Abscess
• Femoral artery aneurysm
• Hydrocoele or varicocele in males
• Lipoma
• Inguinal hernia

Complications

• Incarceration, where the herniated tissue cannot be reduced