II. Epidemiology
- Accounts for 4-10% of Groin Hernias (>90% are Inguinal Hernias)
- Femoral Hernias account for 40% of Hernia-related emergencies (due to Strangulated Hernia or Incarcerated Hernia)
- More common in elderly women
- Gender predisposition: Female by 3 to 1 ratio
- Femoral seen less than Inguinal Hernia even in women
III. Pathophysiology
- Associated with increased intra-abdominal pressure
- Pelvic floor weakness associated with child birth may predispose to Femoral Hernia in women
-
Hernia sac bulges into femoral canal
- Femoral canal is continuation of femoral sheath
- Femoral canal lies immediately medial to femoral vein
IV. Findings: Symptoms and Signs
- Frequently presents as Bowel Obstruction
-
Groin Pain and tenderness often absent
- Even Strangulation occurs often without pain
-
Hernia sac neck location palpable
- Lateral and inferior to pubic tubercle
- Large Femoral Hernias may bulge over inguinal ligament
- May be difficult to distinguish from Inguinal Hernia
V. Differential Diagnosis
- Inguinal Hernia
- Inguinal Lymphadenopathy
- Varix of Saphenous Vein
- Thrill on palpation
- Fills on standing and empties while supine
- Infectious Bubo
VI. Complications
-
Strangulated Hernia (common)
- Patients unaware of Hernia before Strangulation (50%)
- Femoral Hernia is more likely to strangulate than Inguinal Hernia
VII. References
- Goroll (2000) Primary Care Medicine, p. 431-4
- Degowin (1987) Diagnostic Examination, p. 489-96
- Stevens (2013) Crit Dec Emerg Med 27(9): 2
- Bax (2001) Am Fam Physician 59(4):143-56 [PubMed]