II. Epidemiology

  1. Accounts for 4-10% of Groin Hernias (>90% are Inguinal Hernias)
    1. Femoral Hernias account for 40% of Hernia-related emergencies (due to Strangulated Hernia or Incarcerated Hernia)
  2. More common in elderly women
  3. Gender predisposition: Female by 3 to 1 ratio
    1. Femoral seen less than Inguinal Hernia even in women

III. Pathophysiology

  1. Associated with increased intra-abdominal pressure
  2. Pelvic floor weakness associated with child birth may predispose to Femoral Hernia in women
  3. Hernia sac bulges into femoral canal
    1. Femoral canal is continuation of femoral sheath
    2. Femoral canal lies immediately medial to femoral vein

IV. Findings: Symptoms and Signs

  1. Frequently presents as Bowel Obstruction
  2. Groin Pain and tenderness often absent
    1. Even Strangulation occurs often without pain
  3. Hernia sac neck location palpable
    1. Lateral and inferior to pubic tubercle
  4. Large Femoral Hernias may bulge over inguinal ligament
    1. May be difficult to distinguish from Inguinal Hernia

V. Differential Diagnosis

  1. Inguinal Hernia
  2. Inguinal Lymphadenopathy
  3. Varix of Saphenous Vein
    1. Thrill on palpation
    2. Fills on standing and empties while supine
  4. Infectious Bubo
    1. Chancroid
    2. Syphilis
    3. Lymphogranuloma venereum

VI. Complications

  1. Strangulated Hernia (common)
    1. Patients unaware of Hernia before Strangulation (50%)
    2. Femoral Hernia is more likely to strangulate than Inguinal Hernia

VII. References

  1. Goroll (2000) Primary Care Medicine, p. 431-4
  2. Degowin (1987) Diagnostic Examination, p. 489-96
  3. Stevens (2013) Crit Dec Emerg Med 27(9): 2
  4. Bax (2001) Am Fam Physician 59(4):143-56 [PubMed]

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Ontology: Hernia, Femoral (C0019288)

Definition (MSH) A groin hernia occurring inferior to the inguinal ligament and medial to the FEMORAL VEIN and FEMORAL ARTERY. The femoral hernia sac has a small neck but may enlarge considerably when it enters the subcutaneous tissue of the thigh. It is caused by defects in the ABDOMINAL WALL.
Concepts Acquired Abnormality (T020)
MSH D006550
ICD10 K41 , K41.90
SnomedCT 155745001, 155747009, 196851002, 196852009, 196846008, 50063009
English Femoral Hernia, Femoral Hernias, Hernia, Femoral, Hernias, Femoral, Femoral hernia NOS, Unspecified femoral hernia, Unspecified femoral hernia NOS, femoral hernia, abdomen hernia femoral, femoral hernia (diagnosis), femoral hernia (physical finding), Hernia, Femoral [Disease/Finding], femoral hernias, hernia femoral, Hernia;femoral, crural hernia, hernia crural, Femoral hernias, Unspecified femoral hernia NOS (disorder), Unspecified femoral hernia (disorder), Femoral hernia NOS (disorder), Femoral hernia, Crural hernia, Femoral hernia (disorder), Femorocele, femoral; hernia, hernia; femoral, Femoral hernia, NOS
Italian Ernie femorali, Ernia femorale NAS, Ernia femorale
Dutch dijbreuk NAO, femoralis; hernia, hernia; femoralis, dijbeenbreuk, dijbreuk, Hernia femoralis
French Hernie crurale SAI, Hernies fémorales, Hernie crurale, Hernie fémorale
German Hernia femoralis NNB, Femoralhernien, Femoralhernie, Hernia femoralis, Hernie, Femoral-, Schenkelhernie
Portuguese Hérnia femoral NE, Hérnia femoral, Hérnias femorais, Hérnia Femoral
Spanish Hernia femoral NEOM, hernia femoral no especificada, hernia femoral no especificada, SAI, Femoral hernia NOS, hernia femoral no especificada, SAI (trastorno), hernia femoral, SAI (trastorno), hernia femoral, SAI, hernia femoral no especificada (trastorno), hernia crural, hernia femoral (trastorno), hernia femoral, Hernia femoral, Hernias femorales, Hernia Femoral
Japanese 大腿ヘルニアNOS, ダイタイヘルニア, ダイタイヘルニアNOS, 股ヘルニア, 大腿ヘルニア, ヘルニア-大腿
Swedish Femoralbråck
Czech hernie femorální, Stehenní kýly, Stehenní kýla NOS, Stehenní kýla
Finnish Reisityrä
Korean 넓적다리헤르니아
Polish Przepuklina udowa
Hungarian Femoralis sérvek, Femoralis hernia, Femoralis sérv k.m.n.
Norwegian Hernia femoralis, Lårbrokk, Femoralbrokk, Hernie, femoralt, Femoralhernie, Femoralt brokk