Introduction

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 which can become occupied by herniated contents via the femoral ring.

Epidemiology

  • Incidence: 6.00 cases per 100,000 person-years
  • Peak incidence: 70+ years
  • Sex ratio: more common in females 2:1
Condition Relative
incidence
Inguinal hernia83.33
Femoral hernia1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

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 superlateral 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.

Differential diagnosis

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 varicoele in males;
  • Lipoma;
  • Inguinal hernia.

Management

Management
  • Refer both men and women with equal urgency;
  • Surgical repair is a necessity, given the risk of strangulation, and can be carried out either laparoscopically or via a laparotomy;
  • Hernia support belts/trusses should not be used for femoral hernias, again due to the risk of strangulation;
  • In an emergency situation, a laparotomy may be the only option.

Complications

Complications
  • Incarceration, where the herniated tissue cannot be reduced;
  • Strangulation, which can follow on from incarceration, and is a surgical emergency that requires urgent management (see below). These hernias will be tender and likely non-reducible, and may also present with a systemically unwell patient. The risk of strangulation is much higher with femoral hernias than inguinal hernias and increases as the time from diagnosis rises;
  • Bowel obstruction, again a surgical emergency;
  • Bowel ischaemia and resection due to the above, which may lead to significant morbidity and mortality for the patient.