Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.

1. Dr.B.Selvaraj MS;MCh;FICS
Professor of Surgery
Melaka Manipal Medical college
Melaka Malaysia 75150
GROIN SWELLINGS
FEMORAL HERNIA

2. Femoral Hernia- Overview
 Causes of groin swellings
 Classical Clinical Vignette of Femoral Hernia
 Femoral Hernia in detail- one pathology in each
episode
 Mind map of Femoral Hernia
 Algorithm to clinch the correct diagnosis
 Tabular column of differential diagnosis depicting
their characteristic features to differentiate them
from Femoral Hernia

3. Causes of Groin swellings
 Inguinal hernia- Indirect & direct
 Femoral hernia
 Undescended testis
 Inguinal lymphadenitis
 Lipoma of spermatic cord
 Encysted hydrocele
 Saphena varix
 Femoral artery aneurysm
 Psoas abscess
 Femoral nerve neuroma

4. Classical Clinical Vignette
 A 65-year-old obese woman presents to the emergency department
with nausea and vomiting for the past day. The frequency of vomiting
has increased despite the fact that she has not eaten for the past 12
hours.
 For the last few months, she has noticed a painful “lump” in her left
groin that would protrude upon straining, but would quickly disappear
after lying down. She says that the lump appeared a few days ago and
has not gone away even after lying down.
 She has had no bowel movement and no flatus per rectum for the past
24 hours.

5. Classical Clinical Vignette
 O/E:the patient has a low-grade fever (100.2 °F), blood pressure of
120/80 mmHg, and heart rate of 120/min. She appears ill and
uncomfortable with dry mucous membranes.
 Her abdomen is non-tender to palpation, but there is a 2 × 2 cm mass
in the left groin, below and lateral to pubic tubercle. Her abdomen is
mildly distended. Bowel sounds are high pitched- borborygmi+
 The overlying skin is slightly erythematous and the mass is
irreducible.
 Laboratory studies are significant for white blood count of 14.7 × 10 3
(normal 4.1−10.9 × 10 3 /μL).
Femoral Hernia

6. Femoral Hernia
 Herniation of intra-abdominal contents through the femoral canal is
called Femoral hernia.
 It is the third most common type of hernia after inguinal and
incisional hernias.
 Women are more affected than men (2:1) and right side is more
affected than the left. It is bilateral in 15 to 20 percent cases.
 The sac can not pass down into the thigh as the sup fascia of the
abdomen (fascia of Scarpa) is attached to the fascia lata of thigh at
the lower border of the fossa ovalis.
 The shape of the sac thus becomes retort-shaped.

7. Femoral Hernia- Etiology
 Femoral hernia is almost always acquired in nature
 Pregnancy: Repeated pregnancy causes increased abdominal pressure
which is probably an initiating factor. The maximum incidence is
around 30 – 40 yrs.
 Wide femoral canal: This is due to narrow insertion of iliopubic tract
into the pectineal line of the pubis and may be responsible for a few
cases of femoral hernia.

8. Femoral Hernia- Clinical
Features
 Presents as a swelling in the groin below and lateral to the pubic
tubercle (Inguinal hernia is above and medial to the pubic tubercle).
 Swelling, impulse on coughing, reducibility, gurgling sound during
reduction, dragging pain, are the usual features.
 When obstruction and strangulation occurs which is more common,
presents with features of intestinal obstruction—painful, tender,
inflamed, irreducible swelling without any impulse.
 Gaur’s sign: In femoral hernia, distension of superficial epigastric
and/or circumflex iliac veins occurs due to the pressure by the hernial
sac.

9. Femoral Hernia- Clinical
Features

10. Femoral Hernia- Types
 Laugier’s hernia—through lacunar ligament
 Serofini’s hernia—occurs behind femoral
vessels
 Teale’s hernia—in front femoral vessels
 Callison-Cloquet hernia—through pectineal
fascia
 Hesselbach’s hernia—occurs lateral to
femoral artery
 Narath’s hernia—occurs behind femoral
artery, in congenital dislocation of hip

11. Femoral Hernia Vs Inguinal
Hernia

12. Femoral Hernia-
Treatment
 Lockwood-low operation:Here inguinal ligament is
sutured to Cooper’s ligament. Fundus of sac is
dissected by direct vision and repair is done from
below.
 Lotheissen’s operation: It is through inguinal canal
approach. Transversalis fascia is opened and neck
of the sac is identified in the femoral ring. Sac is
dissected from above, neck is ligated and repair is
done. After herniotomy, conjoined tendon is
sutured to iliopectineal ligament by interrupted
sutures (2 or 3), using nonabsorbable
monofilament sutures.

13. Femoral Hernia-
Treatment
 Mc’Evedy-high operation: A incision is made
over the femoral canal extending vertically
above the inguinal ligament. Sac is
dissected from below, neck from above and
repair is done from above. It is done in
strangulated femoral hernia.
 AK Henry’s approach:Repair of bilateral
femoral hernia through lower abdominal
incision.
 Laparoscopic mesh repair:TEP/TAPP.
A-Inguinal incision (Lotheissen’s
approach)
B-Low incision (Lockwood approach)
C-Vertical incision (Mcevedy’s
approach)

14. Femoral Hernia-Complications
Of Surgery
 Seroma/ Hematoma
 Urinary retention
 Wound infection
 Recurrence
 Bleeding from aberrant obturator artery
 Chronic neuralgic pain due to nerve injury or entrapment

15. Femoral Hernia- Mindmap

16. Algorithm for Groin
Swellings

17. D/D for Groin Swellings
Compare & Contrast; Vertical reading