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Hernias > Femoral Hernias

Femoral hernias are not very common, nonetheless are very important to diagnose because they have a high risk of developing complications such as bowel obstruction or strangulation.

Femoral hernias are found just below inguinal hernias. They can be misdiagnosed or missed on examination because they are found in an area where there are many other structures such as lymph glands.

The hernia develops and passes through a narrow passage or canal termed the femoral canal. This canal joins the pelvis to the groin. It is a quite short, tight canal and it is the tightness, which causes the high rates of complications.

Femoral hernias are relatively more common in women.

They appear as a swelling or lump together with pain. The swelling may come and go (reducible) but are usually not able to be reduced (irreducible).

As the hernia enlarges, it may be pushed upwards and this can make it difficult to tell the difference between inguinal hernia and a femoral hernia. Both hernias can be found together occasionally. Surgery is usually recommended for femoral hernia because of the higher risk of complications.

In the non-emergency case it is usually a simple operation requiring only a small cut just below the groin.

The procedure can be carried out using local anaesthetic under light sedation. The hernia is reduced or removed and then the defect closed with suturing or a mesh plug fixed into position.

Some surgeons use a higher approach through the groin or an even higher approach through the muscles of the abdominal wall.

These higher approaches may be used more frequently when the hernia has developed complications such as obstruction or strangulation.

The hernia may also be repaired using "keyhole" surgery – laparoscopic surgery.

Question and answer:

Can a femoral hernia be confused with other conditions?

Yes - can be confused with an inguinal hernia. Can be found together with an inguinal hernia also. In addition, other conditions, which occur in the same area, are:

- Large dilated varicose vein termed a saphena varix

- Lymph nodes – can enlarge in the groin signifying serious conditions such as a lymphoma or a tumour.

The most common cause of enlargement of glands in the groin is termed “reactive”. That means a reaction to an infection or inflammation from a condition such as an infected toenail. The source of infection is not always obvious.

Other conditions, which may occur in this region, are infected cysts, or an abscess.

All these conditions can usually be differentiated from each other by the history and the examination. But often tests are required. Simple tests for differentiation are an ultrasound, which will certainly differentiate between a hernia and a lymph node. The ultrasound can even help diagnose which condition is affecting the lymph node.

Where lymph nodes are enlarged and are a cause of concern, a needle can be placed into the node under ultrasound control and tissue taken out for histological examination or culture if an infection is suspected. Two types of needles can be used in – the very fine needle called needle aspiration cytology or thicker, true cut biopsy needles where a larger specimen is obtained and a more detailed analysis available.

As with any investigation, 100% reliability cannot be guaranteed. Thus, enlarged lymph nodes are sometimes removed surgically.

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