Introduction
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 hernia | 83.33 |
Femoral hernia | 1 |
<1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical 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
- Lymphadenopathy;
- Abscess;
- Femoral artery aneurysm;
- Hydrocoele or varicoele in males;
- Lipoma;
- Inguinal hernia.
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
- 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.