Femoral hernia !
A femoral hernia is a lump in the upper thigh, just below the groin crease, where fat or bowel pushes through the femoral canal; it often gets trapped.
Updated 2026-10-29
Structures involved
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- Inguinal ligament
- Transversalis fascia
- Hip bone
- Inguinal canal
- Peritoneum
- Ileum
- Epigastric vessels
- Genitofemoral nerve
In the clinical exam
What it is
Protrusion of preperitoneal fat or bowel through the femoral canal, below the inguinal ligament, felt as a lump in the upper thigh just below and lateral to the pubic tubercle.
Who gets it
Much less common than inguinal hernia but more common in women than in men, especially older women. Even so, inguinal hernia remains the most common groin hernia in women. Many present as emergencies.
Causes
- Widening of the femoral ring with age
- Raised intra-abdominal pressure
- Previous inguinal hernia repair (a femoral hernia may be missed or appear later)
Risk factors
- Female sex and older age
- Pregnancy and multiparity
- Chronic cough, constipation, heavy lifting
- Previous groin hernia surgery
- Weight loss with loss of preperitoneal fat
Pathophysiology
The femoral ring is bounded by the inguinal ligament in front, the pectineal (Cooper) ligament behind, the lacunar ligament medially and the femoral vein laterally. Because these edges are firm and the opening is narrow, contents that enter it are easily trapped, so incarceration and strangulation are common, including Richter hernia.
Classification
- Reducible, incarcerated or strangulated
- Richter hernia: only part of the bowel wall is trapped, so obstruction may be absent
- Groin hernia classifications (e.g., European Hernia Society) include femoral hernia as a separate type
Symptoms and signs
- Small, firm lump in the upper medial thigh, below the inguinal ligament
- Often not reducible even when not strangulated
- Groin discomfort; many are noticed only when they become painful
- Symptoms of bowel obstruction may be the first sign
Diagnosis
- Clinical
- A lump below and lateral to the pubic tubercle, below the inguinal ligament; an inguinal hernia lies above and medial to it. The groins are always examined in a patient with bowel obstruction.
- Tests
- Blood count, lactate, electrolytes and kidney function if strangulation or obstruction is suspected.
- Imaging
- Ultrasound confirms the hernia and distinguishes it from lymph nodes or vessels. CT is useful in obstruction and shows bowel within the femoral canal.
Differential diagnosis
- Inguinal hernia
- Enlarged inguinal lymph node
- Saphena varix (soft, with a cough impulse and thrill)
- Femoral artery aneurysm (pulsatile)
- Lipoma, psoas abscess or ectopic testis
Goal of treatment
Repair every femoral hernia promptly, because of the high risk of strangulation, and treat any compromised bowel.
Treatment
- Surgical
- Elective repair soon after diagnosis; watchful waiting is not recommended for femoral hernia.
- Surgical
- Laparoscopic preperitoneal mesh repair (TEP or TAPP) covers the femoral and inguinal openings and is favoured in many guidelines when expertise is available.
- Surgical
- Open approaches: low (infrainguinal), high (preperitoneal) or transinguinal, closing the canal with sutures or a mesh plug or patch.
- Acute
- Strangulated hernia: emergency surgery with a high or preperitoneal approach that allows bowel inspection and resection if needed.
Complications
- Incarceration and strangulation
- Small bowel obstruction
- Bowel necrosis and perforation; Richter hernia with late diagnosis
- Recurrence, chronic groin pain, injury to the femoral vein
Prognosis
Elective repair has good outcomes and low recurrence. Emergency presentation with strangulation, more frequent in older women, carries a higher risk of bowel resection and death.
Test yourself
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How is a femoral hernia distinguished from an inguinal hernia on examination?
A femoral hernia lies below the inguinal ligament, below and lateral to the pubic tubercle; an inguinal hernia lies above and medial to it.
What are the boundaries of the femoral ring?
Inguinal ligament anteriorly, pectineal (Cooper) ligament posteriorly, lacunar ligament medially and femoral vein laterally.
Why do femoral hernias strangulate more often than inguinal hernias?
The femoral ring is narrow with rigid ligamentous borders, so trapped contents lose their blood supply quickly.
What is a Richter hernia?
A hernia in which only part of the bowel wall is trapped; it can strangulate without causing complete obstruction.
Is watchful waiting appropriate for a femoral hernia?
No. Because of the high strangulation risk, femoral hernias are repaired promptly once diagnosed.
Related conditions
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Femoral Hernia (StatPearls (NCBI Bookshelf), 2025).
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