Femoral Hernia

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • 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

Imaging Findings

• • US: Although rarely needed, can verify the presence of a femoral hernia sac and reliably differentiate between a hernia and inguinal lymphadenopathy

• • Inguinal hernia

  • Hydrocele

  • Cord mass

  • Strained groin muscle

  • Epididymitis

  • Inguinal lymphadenopathy

  • Varicocele

  • Undescended testes

Rule Out

• • Strained groin muscle (chronic groin pain commonly develops in these following operative intervention)

• • Physical exam usually all that is required to accurately diagnose inguinal hernia

  • In equivocal cases, US may be helpful

When to Admit

• • 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

Surgery

Indications

• • Immediate repair in the case of incarcerated or strangulated femoral hernia repair

  • Uncomplicated femoral hernias can be repaired electively as an outpatient

Treatment Monitoring

• • ...