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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