University of California San Francisco

Femoral (Thigh) Hernia

Femoral hernias are another type of groin hernias, but occur lower in the body than the more common inguinal hernia. Fomoral hernias develop in the upper part of the thigh near the groin just below the inguinal ligament, where abdominal contents pass through a naturally occurring weakness called the femoral canal. Because of the high incidence of complications, femoral hernias often need emergency surgery.

Incidence

Femoral hernias are a relatively uncommon type, accounting for only 3% of all hernias. While femoral hernias can occur in both males and females, they occur approximately 10 times as frequently in women than in men because of the wider bone structure of the female pelvis.

Femoral hernias are more common in adults than in children. Those that do occur in children are more likely to be associated with a connective tissue disorder or with conditions that increase intra-abdominal pressure. Seventy percent of pediatric cases of femoral hernias occur in infants under the age of one.

Causes

Any activity or condition which increases pressure in the intra-abdominal cavity may contribute to the formation of a hernia, including:

  • Obesity
  • Heavy lifting
  • Coughing
  • Straining with urination or defecation
  • Chronic obstructive pulmonary disease (COPD)
  • Ascites
  • Peritoneal dialysis
  • Ventriculoperitoneal shunt 

Signs and Symptoms

  • A bulge in the upper thigh next to the groin
  • Most femoral hernias cause no symptoms. Groin discomfort may worsen when standing, lifting heavy objects, or straining.
  • In severe cases, abdominal pain, nausea, and vomiting 

Incarcerated and Obstructed Inguinal Hernias

An incarcerated femoral hernia is a hernia that becomes stuck in the femoral canal and cannot be massaged back into the abdomen. This type of hernia is also called  "irreducible ".

An obstructed femoral hernia occurs when a part of the intestine becomes intertwined with the hernia, causing an intestinal obstruction. The obstruction may grow and the hernia can become increasingly painful. Vomiting may also result.

Incarcerated and obstructive hernias are caused by imflammation and can lead to a serious lfe-threatening condition known as a strangulated hernia.

Strangulated Hernias

A strangulated femoral hernia occurs when the hernia blocks blood supply to part of the bowel - the loop of bowel loses its blood supply. Strangulation can happen in all hernias, but is more common in femoral and inguinal hernias due to their narrow "necks".

Symptoms of a strangulated hernia include:

  • Extreme tenderness and redness in the area of the bulge
  • Sudden pain that worsens in a short period of time
  • FeverRapid heart rate

Nausea, vomiting, and severe abdominal pain may occur with a strangulated hernia. This is a medical emergency. A strangulated intestine can result in necrosis (tissue death) followed by gangrene (tissue decay). This is a life-threatening condition requiring immediate surgery. Left untreated, severe infection can occur. If surgery is not performed immediately, the condition can become life threatening, and the affected intestine may die and need to be amputated.  

Diagnosis

To diagnose a femoral hernia, a physical examination of the groin area is performed. In obese patients, imaging in the form of ultrasonography, CT or MRI may aid in the diagnosis. In female patients, an abdominal x-ray showing both a painful groin lump and small bowel clearly suggests a femoral hernia

It can be difficult to determine if a hernia is a femoral hernia or an inguinal hernia. They are differenent only in their location relative to the inguinal ligament. A hernia in the groin area above the inguinal ligament is an inguinal hernia; below the ligament a femoral hernia. A highly skilled and experienced surgeon who does the procedure in high volumne is helpful to determine what type of hernia is present. Sometimes this is only evident at the time of surgery.

Treatment

In adults, femoral hernias that enlarge, cause symptoms, or become incarcerated are treated surgically.  Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient. The two main types of surgery for hernias are as follows:

Open Hernia Repair

In open hernia repair, also called herniorrhaphy, a person is given local anesthesia in the abdomen or spine to numb the area, general anesthesia , or a combination of the two. The surgeon makes an incision in the groin, moves the hernia back into the abdomen. Repair is either performed by suturing the inguinal ligament to the pectineal ligament using strong non-absorbable sutures or by placing a mesh plug in the femoral ring.

Laparoscopic Femoral Hernia Repair

Laparoscopic surgery  is a minimally invasive  procedure performed using general anesthesia. The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope-a thin tube with a tiny video camera attached to one end. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh.

People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine laparoscopic surgery is not the best option if the hernia is very large or the person has had pelvic surgery.

Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are restricted for several weeks. The doctor will discuss when a person may safely return to work. Infants and children also experience some discomfort but usually resume normal activities after several days.

Potential Complications

Surgery to repair an inguinal hernia is generally safe and complications are uncommon. Knowing possible risks allows patients to report postoperative symptoms to their doctor as soon as they occur.

  • Risk of general anesthesia. Before surgery, the anesthesiologist-a doctor who administers anesthesia-reviews the risks of anesthesia with the patient and asks about medical history and allergies to medications. Complications most likely occur in older people and those with other medical conditions. Common complications include nausea, vomiting, urinary retention, sore throat, and headache. More serious problems include heart attack, stroke, pneumonia, and blood clots in the legs.

    Getting out of bed after surgery and moving as soon as the doctor allows will help reduce the risk of complications such as pneumonia and blood clots.

  • Hernia recurrence. A hernia can recur up to several years after repair. Recurrence is the most common complication of inguinal hernia repair, causing patients to undergo a second operation.

  • Bleeding. Bleeding inside the incision is another complication of inguinal hernia repair. It can cause severe swelling and bluish discoloration of the skin around the incision. Surgery may be necessary to open the incision and stop the bleeding. Bleeding is unusual and occurs in less than 2 percent of patients.

  • Wound infection. The risk of wound infection is small-less than 2 percent-and is more likely to occur in older adults and people who undergo more complex hernia repair.2 The person may experience a fever, discharge from the incision, and redness, swelling, or tenderness around the incision. Postoperative infection requires antibiotics and, occasionally, another procedure requiring local anesthesia to make a small opening in the incision and drain the infection.

  • Painful scar. Sometimes people experience sharp, tingling pain in a specific area near the incision after it has healed. The pain usually resolves with time. Medicine may be injected in the area if the pain continues.

  • Injury to internal organs. Although extremely rare, injury to the intestine, bladder, kidneys, nerves and blood vessels leading to the legs, internal female organs, and vas deferens-the tube that carries sperm-can occur during hernia surgery and may lead to more operations.

For More Information

Inguinal and Femoral Hernia Repair (American College of Surgeons)