• Clinical science

Femoral hernia

Summary

A femoral hernia is an uncommon type of inguinal hernia, in which intra-abdominal contents (e.g., intraperitoneal fat, mesentery, bowels) herniate into the femoral canal through the femoral ring. Risk factors for femoral hernias include old age, female gender, obesity, and previous hernia repair. Patients present with a globular swelling inferior to the inguinal ligament and medial to the femoral vein that worsens with coughing or straining. The diagnosis is primarily clinical with ultrasonography being indicated if the diagnosis is inconclusive. Although femoral hernias are uncommon, they are associated with a high risk of incarceration and strangulation and should, therefore, be surgically treated as early as possible. The preferred treatment for non-complicated femoral hernias is mesh hernioplasty, while repair without a mesh is used for complicated femoral hernias.

Epidemiology

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Advancing age and female gender (see “Epidemiology” above)
  • Increased intra-abdominal pressure
  • Multiparity
  • Previous abdominal surgeries (especially those involving the inguinal region)

In contrast to indirect inguinal hernias, which may occur congenitally, femoral hernias are almost always acquired.
References:[3]

Pathophysiology

To remember the femoral triangle contents, think NAVEL: (from lateral to medial) femoral Nerve, Artery, Vein, Empty space (femoral canal → femoral hernia), Lymphatics


References:[4][2]

Clinical features

References:[2][5]

Diagnostics

  • A femoral hernia is primarily a clinical diagnosis.
  • Groin ultrasound is used when the diagnosis is inconclusive (see “Differential diagnosis” below).

Femoral hernias can be difficult to palpate in obese patients. Ultrasound is indicated if a femoral hernia is suspected in this patient group!

References:[6]

Differential diagnoses

References:[2]

The differential diagnoses listed here are not exhaustive.

Treatment

  • Non-complicated femoral hernia: early elective surgical repair with mesh hernioplasty (tension-free repair)
  • Complicated femoral hernia: (see “Complications” below): herniorrhaphy (non-mesh repair)

All femoral hernias should be surgically repaired because of the high risk of complications.

References:[7][8][9][10]

Complications

Reduction of a strangulated hernia should not be attempted because generalized peritonitis would occur following reduction of strangulated bowel loops!

Although femoral hernias account for only about 5% of all hernias, they account for about 40% of all complicated hernias!

A femoral hernia should be considered among 40–70-year-old women presenting with signs of mechanical bowel obstruction!

References:[6][9][11][12]

We list the most important complications. The selection is not exhaustive.