A hernia occurs when an organ or fatty tissue pushes through a weak spot in the muscle or tissue wall that normally contains it. A femoral hernia is a specific type of groin hernia, less common than an inguinal hernia, but carrying a higher risk of complications. It involves a protrusion of a sac, often containing part of the intestine, into the upper thigh area. This condition arises from a weakness in the lower abdominal wall, allowing abdominal contents to be forced out.
Anatomical Location and Mechanism of Formation
The femoral hernia emerges through the femoral canal, a narrow passageway located just below the inguinal ligament. This canal, which normally houses lymph vessels and fat, is situated next to the large femoral vein and artery that supply the leg. The borders of the canal are rigid, defined by ligaments, including the inguinal ligament above and the bony structure of the pelvis below.
The protrusion occurs when increased pressure inside the abdomen forces tissue through the femoral ring, the opening to the canal. Because the femoral canal is structurally tight and surrounded by stiff tissue, the tissue pushed through is easily constricted. This narrowness makes femoral hernias particularly vulnerable to serious complications.
Recognizing the Signs and Who is at Risk
A femoral hernia typically presents as a small, mildly uncomfortable lump in the upper thigh or groin area. This bulge is usually situated just below the crease where the abdomen meets the leg. The lump may become more noticeable when standing, coughing, or straining, and it might disappear or become smaller when lying down.
Initial symptoms often involve a dull ache, a feeling of dragging, or a slight burning sensation in the groin. Femoral hernias are significantly more common in women; the wider female pelvic structure is thought to contribute to a slightly larger or weaker femoral canal opening. Risk factors are linked to conditions that chronically increase pressure within the abdomen.
These conditions include chronic constipation or straining during bowel movements, persistent heavy lifting, or having a chronic cough. Obesity and a history of pregnancy or childbirth also place extra strain on the abdominal wall, which can lead to the development of a weak spot.
Urgent Concerns: Understanding Strangulation
The greatest danger associated with a femoral hernia is the high risk of strangulation, which accounts for up to 20% of cases presenting for repair. Strangulation occurs when the narrow, rigid neck of the femoral canal tightly constricts the herniated tissue, cutting off its blood supply. This loss of blood flow can quickly lead to tissue death (necrosis), which is a life-threatening complication.
The signs of a strangulated hernia constitute a medical emergency that requires immediate attention. Symptoms include the sudden onset of severe, escalating pain at the hernia site. The lump itself will become firm, tender to the touch, and non-reducible, meaning it cannot be gently pushed back into the abdomen.
Systemic symptoms can also develop rapidly, such as nausea, vomiting, and fever, especially if a segment of the intestine is caught and becomes obstructed. Anyone experiencing these acute signs must seek emergency medical care immediately to prevent tissue damage and widespread infection.
Diagnosis and Surgical Repair
Diagnosis usually begins with a thorough physical examination, where a physician assesses the location and characteristics of the lump. The doctor will attempt to determine if the hernia is “reducible,” meaning the tissue can be pushed back into the abdominal cavity. Imaging studies, such as an ultrasound or a computed tomography (CT) scan, may be used to confirm the diagnosis or assess the contents of the hernia sac if the physical exam is unclear.
Because of the high risk for strangulation, surgical repair is almost always recommended, even if the hernia is not currently causing symptoms. The goal of the surgery is to push the herniated tissue back into the abdomen and then permanently close or reinforce the weak spot in the femoral canal. Repair can be performed through open surgery (a single incision near the groin) or through a laparoscopic (keyhole) technique using several small incisions.
Many repairs utilize a synthetic mesh to strengthen the opening and prevent recurrence. Choice of technique depends on the patient’s overall health and whether the procedure is performed electively or as an emergency. Emergency surgery for a strangulated hernia focuses on saving the compromised tissue, which may involve removing a section of damaged intestine before repairing the defect.