Femoral hernia

Dr. med. Mira Seidel is a freelance writer for the medical team.

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A femoral hernia (femoral hernia, femoral hernia, hernia femoralis) is a hernia of the intestine, below the so-called inguinal ligament. The pain is often unspecific and can radiate into the thigh. A femoral hernia is always operated on because, for example, parts of the intestine can become trapped. Read more about the symptoms, diagnosis and treatment of femoral hernia here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. K41

Femoral hernia: description

In the femoral hernia, a so-called hernial sac protrudes through a weak point in the tissue. The doctor can feel and see this, especially when there is increased pressure in the abdomen. A femoral fracture consists of a hernial port, a hernial sac and the contents of the hernia. In the femoral hernia, the hernial opening is a maximum of one centimeter wide and is located below the inguinal ligament on the thigh. The hernial sac often contains intestinal parts.

Femoral hernias are about five percent of all hernias. It occurs three times more often in women than in men and particularly affects older women. In around 40 percent of femoral hernias, the hernial sac is already trapped when the diagnosis is made. Nine percent of women and 50 percent of men suffer from an inguinal hernia at the same time.

Femoral hernia: symptoms

Femoral hernias usually do not cause any symptoms at the beginning. If pain occurs, it is often uncharacteristic and located in the groin region. Particularly during physical exertion, the pain radiates into the thigh and swelling occurs in the groin. Sometimes the swelling is mistaken for a lymph node located there. If the hernial sac is trapped, the pain often radiates into the groin, abdomen and inside of the thigh.

Femoral hernia: causes and risk factors

The femoral hernia is caused by a weak point in the tissue of the abdominal wall. This consists of the abdominal muscle and connective tissue structures such as so-called aponeuroses and fasciae, which ensure optimal stability. However, there are “gaps” in the groin region that are not supported by an aponeurosis or muscle and thus represent a natural weak point.

In the femoral hernia, this “predetermined breaking point” is located behind the inguinal ligament, where the vessels of the thigh run. If there is excessive pressure in the abdomen and weak connective tissue, a femoral hernia can occur there.

It is not yet clear why the femoral hernia develops in some people. However, there are several causes that can favor a femoral hernia:

These include in particular repeated pregnancies, obesity and collagen weakness that increases with age. In certain clinical pictures, such as Marfan syndrome or Ehlers-Danlos syndrome, there is a congenital collagen metabolism disorder.

In addition, a femoral hernia often occurs after an inguinal hernia operation - for example due to the surgical technique used. Coughing, pressing or heavy lifting also increases the pressure in the abdomen, so that tissue can escape.

Femoral hernia: examinations and diagnosis

If a femoral hernia occurs, you should consult a specialist in surgery and visceral surgery. The doctor will first take your medical history and then examine you closely. Possible questions from the doctor can include:

How long have the complaints existed?
Have you ever had an operation?
Is the pain radiating?
Do you have an accompanying illness that is associated with a collagen metabolism disorder?

The doctor examines the femoral hernia while lying down and standing. He asks you to press hard once. If he can feel the hernial sac below the inguinal ligament, the diagnosis is easy to make - in overweight people, palpation is often difficult. With an ultrasound examination, the doctor can differentiate the femoral hernia from an inguinal hernia in the case of larger fractures. Any swollen lymph nodes are also excluded.

Femoral hernia: treatment

A femoral hernia is always operated on because it cannot regress on its own. Due to the small hernial opening, sections of the intestine can easily become trapped. Surgery is then required.

Depending on whether a femoral hernia occurs alone or together with an inguinal hernia, different surgical techniques are used. In addition to the classic, open operation, the keyhole technique (minimally invasive) can also be used as an alternative. The surgeon only makes very small abdominal incisions through which he introduces his instruments.

Femoral hernia surgery: Open surgery

In an open femoral hernia surgery, the hernial sac is opened either from the groin area or from the thigh area. The hernial sac is then removed, pushed back and closed.

Isolated femoral hernia

In the case of an isolated femoral hernia, the surgeon operates without opening the inguinal canal. The skin incision is made at an angle below the inguinal ligament. After the hernia has been pushed back, the hernia is sutured.

Closed operation

If a femoral hernia can be pushed back, the operation with the so-called keyhole technique is possible. With this gentle surgical method, only very small skin incisions are made, through which the surgeon introduces the surgical instrument and an optical device for orientation (laparoscope). The doctor may use a plastic mesh to stabilize the femoral hernia port.