Femoral Hernia
Abdominal contents push through the narrow, rigid femoral canal below and lateral to the pubic tubercle, and because that canal is tighter and less compliant than the inguinal canal, femoral hernias carry a much higher risk of strangulation and are treated as surgical emergencies until proven otherwise.
Definition
A femoral hernia is protrusion of abdominal contents through the femoral canal, presenting as a lump in the groin below and lateral to the pubic tubercle. It has a high risk of strangulation and generally warrants prompt surgical repair.
First principles
The femoral canal is a tight space that was never meant to stretch
The femoral canal lies medial to the femoral vein, within the femoral sheath, and normally contains only lymphatics and fat: it exists as a space to allow the femoral vein room to expand, not as a passage for bowel. It is bounded by the inguinal ligament anteriorly, the pectineal ligament posteriorly, the femoral vein laterally and the lacunar ligament medially, a rigid, narrow ring on almost every side. When intra-abdominal pressure forces peritoneum and bowel into this space, the hernia emerges below and lateral to the pubic tubercle, which is the anatomical fact that distinguishes it from an inguinal hernia.
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