Femoral hernias: Clinical sciences

A femoral hernia is the protrusion of abdominal contents, such as preperitoneal fat, omentum, or bowel, through a defect in the lower abdominal wall, which passes through the femoral canal and eventually exits through the femoral ring.

Anatomically, the boundaries of the femoral ring include the lacunar ligament medially, the femoral vein laterally, the pectineal ligament posteriorly, and the inguinal ligament anteriorly. A femoral hernia usually occurs just inferior to the inguinal ligament and lateral to the pubic tubercle.

Some risk factors can increase the chance of developing a femoral hernia. For example, biological females are more likely to develop femoral hernias due to a larger distance between the pubic tubercle and internal ring, as well as a wider rectus abdominis muscle. Other risk factors in both males and females include age-related atrophy of the pectineus muscle, as well as widening of the femoral ring either due to injury or age.

Femoral hernias can present in four ways: asymptomatic, symptomatic, incarcerated, or strangulated. Keep in mind that femoral hernias are more likely to incarcerate and strangulate than other types of hernias, such as inguinal hernias, so they might need immediate attention.

Alright, you should first perform an ABCDE assessment to determine if the patient is stable or unstable. If the patient is unstable, stabilize their airway, breathing, and circulation. This means that you might need to intubate the patient, establish IV access, and administer fluids before continuing with your assessment.

Now that unstable patients are stabilized, let’s go back to the ABCDE assessment and talk about stable patients. If the patient is stable, your first step will be to obtain a focused history and physical examination. There are a few findings you might see here. First, some patients will present with asymptomatic hernias. In this case, they don’t have any symptoms. However, physical examination reveals a small bulge in the groin area inferior to the inguinal ligament. The bulge can be easily reduced. In this case, you are dealing with an asymptomatic femoral hernia.

Even though your patient is currently asymptomatic, femoral hernias have a high chance of incarceration and strangulation and they should be repaired as soon as possible. So, you should call the surgical team for an elective repair. In the meantime, advise your patient on seeking immediate medical care if they develop sudden, severe pain in the groin.