Harvey's Garden

Femoral hernia

2 min read

  • Anatomy/Pathophysiology
    • Protrusion of abdominal contents through the femoral ring and into the femoral canal.
    • The hernia is located below the inguinal ligament. This is a key distinguishing feature from an inguinal hernia, which is above the ligament.
    • The femoral canal is bordered by the inguinal ligament (superiorly), Cooper’s ligament (inferiorly), femoral vein (laterally), and lacunar ligament (medially).
    • A useful mnemonic for structures in the femoral triangle from lateral to medial is NAVEL: Nerve, Artery, Vein, Empty space (femoral canal), Lymphatics. The hernia occurs in the “E”.
  • Epidemiology/Risk Factors
    • More common in women (approx. 3:1 ratio) due to the wider anatomy of the female pelvis.
    • Risk factors include anything that increases intra-abdominal pressure: multiparity, obesity, chronic cough, and chronic constipation.
  • Clinical Presentation
    • Often presents as a lump or bulge in the groin or upper medial thigh.
    • May be asymptomatic or cause a dull ache, worsened by straining or standing.
    • Because the femoral ring is narrow and rigid, these hernias present as an emergency (obstruction or strangulation) in about 30% of cases.
  • Diagnosis (Dx)
    • Primarily a clinical diagnosis based on physical exam.
    • The bulge is typically found inferior and lateral to the pubic tubercle.
    • Ultrasound can be used to confirm the diagnosis, especially in obese patients or when the diagnosis is uncertain.
  • Management (Tx)
    • Surgical repair is recommended for all femoral hernias, even if asymptomatic.
    • This is due to the very high risk of complications compared to inguinal hernias.
    • Elective repair should ideally be done within two weeks of diagnosis.
    • A strangulated hernia is a surgical emergency requiring immediate intervention.
  • Complications/Key Associations
    • High risk of incarceration and strangulation (~15-20%) due to the narrow, rigid nature of the femoral ring.
    • Incarceration: Hernia contents are trapped and cannot be reduced.
    • Strangulation: Blood supply to the herniated contents is compromised, leading to ischemia and necrosis. This is a life-threatening emergency.
    • Richter’s hernia is more common with femoral hernias, where only one side of the bowel wall is entrapped, so symptoms of obstruction may be absent initially.

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