A femoral hernia occurs when abdominal contents push through a weakness in the abdominal wall into the femoral canal.
Contents may include peritoneum, fat, or small bowel, with a high risk of strangulation due to the narrow neck of the canal.

🎯 Risk Factors

👩 Females are 10x more likely than males (wider pelvis).
Obesity, heavy lifting, chronic cough (COPD), constipation/straining.
Ascites, post-operative weakness, urinary obstruction.

🔎 Types of Femoral Hernias

Reducible: Contents can be pushed back.
Incarcerated: Non-reducible, risk of obstruction.
Strangulated: Blood supply compromised → 🚨 surgical emergency.

📊 Comparison: Femoral vs Inguinal Hernias

Feature	Femoral Hernia	Inguinal Hernia
👥 Typical Patient	Older women (wider pelvis)	Young to middle-aged men
📍 Location	Below inguinal ligament, lateral to pubic tubercle	Above inguinal ligament, medial or lateral to inferior epigastric vessels
🧵 Neck of Hernia	Narrow → high risk of strangulation 🚨	Wider → lower risk of strangulation
🩺 Clinical Features	Small lump in groin, tender if incarcerated, often difficult to reduce	Groin lump enlarges on coughing/straining, often reducible
🔎 Examination Clues	Swelling below & lateral to pubic tubercle	Swelling above & medial/lateral to pubic tubercle
⚕️ Management	Urgent surgery due to strangulation risk	Elective repair unless obstructed/strangulated
📉 Complications	Obstruction, strangulation, bowel necrosis	Less likely strangulation, but recurrence possible

🩺 Clinical Presentation

Groin swelling below the inguinal ligament, lateral to pubic tubercle.
Asymptomatic in many cases; pain/tenderness → consider strangulation.
Discomfort worse with standing, lifting, or straining.
🚨 Abdominal pain, vomiting → suspect obstruction/strangulation.

🧪 Investigations

USS, CT, or MRI may confirm diagnosis and detect complications.

⚕️ Management

Acute: ABC, IV fluids, analgesia, NBM, urgent surgical review. 🚨 Strangulated → IV antibiotics + emergency surgery.
Delayed: Laparotomy + bowel resection if ischaemic bowel; elective repair if uncomplicated.

🔨 Surgical Approaches

Open repair: Local anaesthetic; reduce hernia, suture inguinal → pectineal ligament ± mesh.
Laparoscopic repair: General anaesthetic; mesh via keyhole incisions. Minimally invasive, faster recovery. Preferred unless very large/previous pelvic surgery.

⚠️ Potential Complications

General anaesthesia risks: nausea, sore throat, MI, stroke, pneumonia.
DVT/PE → 💡 early mobilisation reduces risk.
Recurrence → may need re-operation.
Bleeding, bruising, wound infection (<2%).
Chronic scar pain or tingling.
Rare: injury to bowel, bladder, or vessels.

📚 References

Anatomy of Femoral Hernias – Kenhub

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Femoral Hernia

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