Femoral Hernia: The Complete Guide
A femoral hernia appears below the inguinal ligament in the upper thigh. It is a small fraction of groin hernias but carries the highest risk of incarceration and strangulation, so prompt repair is recommended.
Contents
What is a femoral hernia?
A femoral hernia is the protrusion of fat or bowel through the femoral canal, a narrow passage below the inguinal ligament next to the femoral vein. Because this opening is narrow and rigid, anything that enters it is prone to trapping. It differs from the inguinal hernia, which lies above the ligament. See the complete hernia guide.
Who is at risk?
Women (several times more than men, due to a wider pelvis), the elderly, women after multiple pregnancies, thin older women, and anyone with raised abdominal pressure. Even so, inguinal hernia remains more common than femoral hernia in women.
Why is it dangerous?
- A small share of groin hernias but a large share of emergency and strangulated cases.
- Strangulation risk rises sharply in the first months after it appears.
- Many patients are diagnosed for the first time in the emergency department with bowel obstruction.
- Richter's hernia may occur, delaying diagnosis.
International guidelines recommend repairing femoral hernias in almost all cases, as soon as possible after diagnosis. Watchful waiting is not advised.
Symptoms
A small lump in the inner upper thigh below the groin crease, often not fully reducible, with groin or thigh pain on standing or lifting — or, at first presentation, severe pain, vomiting and abdominal distension due to strangulation.
Diagnosis
Clinical distinction from inguinal hernia or lymph nodes can be difficult. Ultrasound is first-line; CT helps in unclear or emergency cases. Laparoscopy often reveals an occult femoral hernia during inguinal repair in women — another reason laparoscopy is preferred for female groin hernias.
Treatment
- Elective: laparoscopic TEP/TAPP is preferred in guidelines because it clearly exposes and covers the femoral canal along with other groin openings. Open mesh repair is a good alternative, especially when general anaesthesia is not suitable.
- Emergency: urgent surgery to release the trapped bowel and assess viability; a bowel resection may be needed. Early planned repair is much safer.
See complications and strangulation and types of hernia surgery.
Frequently asked questions
What is the difference between femoral and inguinal hernia?
Can a femoral hernia be observed without surgery?
Can a femoral hernia be repaired laparoscopically?
Scientific references
⚠ This website is for health education and does not replace a medical examination. If you develop sudden severe pain at a hernia, vomiting, or the bulge changes colour, go to the emergency department immediately.