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Femoral

What is a Femoral Hernia?

A femoral hernia is a bulge that forms when a part of the peritoneal sac (abdominal wall), consisting of fatty tissue, intestine or other structures, protrudes and is visible just below your lower abdomen and upper thigh, near your groin crease or labia (skin folds around the vagina). The bulge is pushed into your femoral canal through which your nerves and blood vessels run into the thigh region.

Femoral hernia is an uncommon type of hernia which has the probability of occurring in about one in every 20 hernias of the groin. Femoral hernia commonly occurs in women, mostly older women, because they have wider pelvises and a larger femoral canal than men. It is rarely seen in children. Femoral hernia can sometimes manifest suddenly due to abdominal pressure while straining during constipation or while you push or carry heavy objects. Obesity, pregnancy or persistent cough may also be a cause for this type of hernia.

Femoral hernia is most often mistaken for inguinal hernia, and when diagnosed, should be treated as an emergency condition.

Signs & Symptoms

Small or moderate femoral hernias generally do not show any symptoms. In certain cases, even the bulge may not be visible with small hernias. However, large femoral hernias may manifest as a bulge and can be associated with some discomfort. The bulge may get larger on coughing or straining. Large hernias may cause pain when you exert pressure, while standing up or lifting heavy objects. Some other symptoms include:

  • Hip pain due to closeness of the hernia to the hip region
  • Numbness or irritation due to pressure placed on the nerves in the femoral canal

If you experience severe abdominal and groin pain or the lump is reddish and tender, there may be a chance your intestine is obstructed (stuck in the femoral canal) or strangulated (trapped). Strangulation may block blood flow to the part of your intestine that is stuck and cause tissue necrosis (death of tissue) which may endanger your life. A trapped or obstructed femoral hernia may cause the following symptoms:

  • Groin pain
  • Nausea or vomiting
  • Abdominal pain

Presence of these symptoms requires an emergency hernia repair to release the trapped tissue.

Screening & Diagnosis

Physical examination is the first line of diagnosis to test the external femoral bulge. The bulge will be examined for its texture, size and protrusion. Your doctor will check for skin discolouration, inflammation or dark patches on the surface of the bulge to rule out gangrene (death of tissue). However, your doctor may find it difficult to feel the bulge if it’s small in size.

If the hernia cannot be detected with physical examination, your doctor may order ultrasound of the abdomen or groin. Other imaging tests such as diagnostic X-rays, magnetic resonance imaging (MRI) or computer tomography (CT) scan may be performed to check for the protruding issue.

Laboratory tests may be suggested to confirm serious femoral hernias.

  • Blood tests for evaluating:
    • White blood cell count which indicates presence of infection, inflammation or tissue death.
    • Red blood cell count to determine internal bleeding and blood loss, or blocked circulation.
  • Stool tests which can indicate irregular bowels, a common symptom of entrapment of the internal abdominal organs.

If required, your doctor may order special tests including:

  • Biopsy: Your doctor may suggest a biopsy to detect severe conditions like cancer at the herniated site.
  • Herniagram: A radio-opaque liquid is injected into the abdominal cavity which collects in the cavity. This region will show up on the X-ray images of the bulging area, confirming the presence of hernia.

Treatment Options

Femoral hernia usually requires surgical repair due to its high risk of bowel obstruction or strangulation (trapped). Your surgeon will push the bulged organ back to its place and close or provide support to the weakened area of the abdominal cavity.

Your surgeon may perform either an open or a laparoscopic surgery to repair the femoral hernia. These procedures will be performed under the effect of general anaesthesia. Local anaesthesia and medicines to help you relax may be administered for repairing a small hernia.

Open Surgery

During the procedure, a single 3 to 4 cm long incision will be made over the bulge or in your lower abdomen and the bulge will be separated from the surrounding tissues. Your surgeon may remove any excess tissue if required. The part of your protruded peritoneal sac will be pushed back into the abdomen. The muscles of the weak abdominal wall may either be stitched (Herniorrhaphy) or a piece of mesh may be sutured (Hernioplasty) in place to strengthen it.

Bowel resection (removal of a part of the intestine) may be required during an open surgery if the intestine is trapped and damaged inside the bulge or if fecal matter gets trapped inside. Your surgeon will cut off the damaged bowel and rejoin the ends of the healthy bowel.

Laparoscopic Surgery

During laparoscopy, your surgeon will make 3 to 4 small incisions on the abdominal wall. A laparoscope (thin tube with a lighted device and a camera on its end) is inserted through one of the incisions and special surgical instruments are placed in through the other incisions. The peritoneal sac is pushed back in place and muscles of the abdominal wall are repaired by using either Hernioplasty or Herniorrhaphy.

  • American College of Surgeons
  • American Society for Metabolic & Bariatric Surgery
  • American Medical Association
  • Case Western Reserve University
  • Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program