A hernia occurs when an internal organ or fatty tissue pushes through a weakness or tear in the surrounding muscle or tissue wall. A femoral hernia represents a specific, less common type of abdominal wall hernia that develops in the upper thigh and groin region. While all hernias require attention, the distinct location and anatomy of the femoral hernia make it a condition that often warrants prompt medical evaluation.
Defining the Femoral Hernia
A femoral hernia is formed when a loop of intestine or a piece of fatty tissue protrudes through the femoral canal. This canal is a narrow, cone-shaped passage located in the upper part of the thigh, just below the inguinal ligament. The contents of the abdomen push through this naturally occurring weak spot, often appearing as a bulge near the groin crease.
The femoral canal is positioned immediately next to major blood vessels, specifically the femoral artery and vein, as they travel into the leg. It is important to distinguish a femoral hernia from the much more common inguinal hernia, which occurs above the inguinal ligament in the inguinal canal. Femoral hernias are generally smaller and tend to protrude lower into the upper inner thigh area.
Identifying Symptoms and Risk Factors
The most common sign of a femoral hernia is a lump or bulge that appears in the upper thigh, directly below the groin. In its early stages, this bulge may be small and difficult to detect, especially in individuals with obesity.
Patients often report pain or discomfort in the groin that worsens with physical activities, such as standing or lifting. Sometimes, however, a femoral hernia may produce no noticeable symptoms at all.
Femoral hernias are far more common in women than in men, with some sources indicating they occur up to 10 times more frequently in women. This is attributed to the wider bone structure of the female pelvis, which creates a larger femoral canal. Lifestyle factors that increase pressure inside the abdomen also raise the risk, including chronic coughing, straining due to constipation, heavy lifting, and obesity.
Diagnosis and Urgency
Diagnosis typically begins with a physical examination where a healthcare provider assesses the presence and location of the bulge. If the findings are inconclusive, imaging tests like an ultrasound or a CT scan may be used to confirm the diagnosis and rule out other conditions. Once a femoral hernia is identified, experts strongly recommend surgical repair, even if the patient is not experiencing symptoms, due to the high probability of complications.
The urgency stems from the narrowness of the femoral canal, which makes femoral hernias highly susceptible to a complication called incarceration. Incarceration occurs when the tissue becomes trapped and cannot be pushed back into the abdomen. Strangulation, where the blood supply to the trapped tissue is cut off, is a severe medical emergency.
Strangulation can lead to tissue death, or necrosis, within hours. The signs of strangulation are acute and include the sudden onset of severe groin or thigh pain, abdominal pain, nausea, and vomiting. The area of the bulge may become extremely tender, discolored, or red. Immediate surgical intervention is required if these signs appear to prevent serious complications like gangrene.
Surgical Repair Options
Surgical repair is the only definitive treatment for a femoral hernia, and it is usually recommended shortly after diagnosis to avoid the risk of strangulation. The procedure, known as a herniorrhaphy or hernioplasty, involves returning the protruding tissue to the abdominal cavity and repairing the weakened area.
Open surgery requires a single incision near the groin. The contents are pushed back, and the defect is then repaired, often utilizing surgical mesh to reinforce the weakened muscle wall. Minimally invasive methods, such as laparoscopic surgery, involve making several smaller cuts through which specialized instruments and a camera are inserted.
Laparoscopic repair can be performed using techniques like the Transabdominal Preperitoneal (TAPP) or Totally Extraperitoneal (TEP) approach. The use of a synthetic mesh to reinforce the repair is common in both open and laparoscopic procedures, as this helps to decrease the risk of the hernia recurring. The choice of surgical method depends on the surgeon’s expertise, the patient’s overall health, and whether the hernia is an emergency case.