• Groin bulge inferior to the inguinal ligament elicited with the Valsalva maneuver
• Differentiation between inguinal and femoral hernias difficult clinically and often not appreciated until the hernia sac is dissected free in the operating room
• Femoral hernia protrudes through the femoral canal, bordered by the inguinal ligament superiorly, pubic ramus inferior-medially, and the femoral vein laterally
• Classification of hernias
-Reducible: Visceral contents of the hernia sac able to retract into the abdominal cavity
-Incarcerated: Visceral contents cannot be returned to the abdominal cavity
-Strangulated: Incarcerated hernia where the blood flow to the entrapped viscera is compromised
• 1.8:1 female predominance is seen with femoral hernia formation
• Compared with inguinal hernias, femoral hernias more likely to present as incarcerated with or without strangulation
• Femoral hernias are much less common than inguinal hernias
• Asymptomatic inguinal bulge most common symptom
• Exam of the groin reveals a bulge inferior to the inguinal ligament that may extend onto the thigh
• The hernia bulge may or may not be reducible
• Patients may complain of a fullness or dragging sensation
• As the hernia enlarges, it is likely to produce a sense of discomfort that may radiate onto the ipsilateral thigh or groin
• Incarcerated (and especially strangulated) inguinal hernia bulge is exquisitely painful
• Coughing or straining will help demonstrate small hernias
• Small bowel obstruction symptoms (nausea, vomiting, abdominal distention) may be present with incarcerated femoral hernias
• Physical exam usually all that is required to accurately diagnose inguinal hernia
• In equivocal cases, US may be helpful
• Acute hernia incarceration
• Clinical evidence of strangulation
• Associated small bowel obstruction
• Uncomplicated femoral hernia management can be performed as an outpatient
• Femoral hernias should be surgically repaired unless there are specific contraindications
• Several successful repairs available including native tissue or prosthetic mesh repair
• Femoral hernia repair may be performed via upper thigh incision or with a standard transverse inguinal incision
• Both open and laparoscopic repairs are commonly used
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