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 sex, 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.
- Advancing age and female sex (see “Epidemiology” above)
- Increased intra-abdominal pressure
- Previous abdominal surgeries (especially those involving the inguinal region)
- Boundaries of the femoral canal
- Typical femoral hernia: (common): protrusion of intraperitoneal contents along with the transverse abdominal fascia through the femoral ring into the femoral canal
- Non-complicated femoral hernia
- Complicated femoral hernia: see “Complications” below
- A femoral hernia is primarily a clinical diagnosis.
- Groin ultrasound is used when the diagnosis is inconclusive (see “Differential diagnosis” below).
- Direct or indirect (see “Overview of hernias”)
- Femoral pseudohernia
- Lymph node enlargement
- Femoral artery aneurysm
- Saphenous varix: a dilated, saccular swelling of the great saphenous vein that lies just distal to the junction of the femoral vein and the great saphenous vein
- Psoas abscess
The differential diagnoses listed here are not exhaustive.
- 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.
Incarceration: irreducible femoral hernia due to trapped hernia contents in hernia sac
- Richter hernia: herniation of only a part of the circumference of the bowel wall.
- Strangulation: ischemic necrosis of contents within the hernia sac as blood flow is compromised due to incarceration
We list the most important complications. The selection is not exhaustive.