Practice Easily Missed?

Femoral hernias

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7668 (Published 08 December 2011) Cite this as: BMJ 2011;343:d7668
  1. Henry Robert Whalen, clinical research fellow 1,
  2. Gillian A Kidd, general practitioner2,
  3. Patrick J O’Dwyer, professor of surgery1
  1. 1University Department of Surgery, Western Infirmary, Glasgow G11 6NT, UK
  2. 2Midlock Medical Centre, General Practice, Glasgow, UK
  1. Correspondence to: H R Whalen Henry.Whalen{at}gjnh.scot.nhs.uk

An overweight 65 year old woman visits her general practitioner with discomfort in her right groin. On examination, the suggestion of a reducible groin lump is noted. She is routinely referred to the surgical outpatient clinic with a possible diagnosis of inguinal hernia. However, two weeks later and before her surgical appointment, she again visits her general practitioner, this time with vomiting, diarrhoea, and colicky abdominal pain. She is immediately referred to the emergency department. An abdominal radiograph shows small bowel obstruction. She is admitted to the surgical ward with a diagnosis of obstructed femoral hernia and has a small bowel resection and emergency hernia repair.

What is a femoral hernia?

A femoral hernia is the protrusion of a peritoneal sac through the femoral ring into the femoral canal, posterior and inferior to the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures.

How common are femoral hernias?

  • About 5000 femoral hernia repairs are carried out in the United Kingdom each year

  • Femoral hernias account for a fifth of all groin hernias in females but less than 1% of groin hernias in males

  • The 40% of femoral hernias that present acutely are associated with a 10-fold increased risk of mortality1 2

Why is a femoral hernia missed?

Evidence is scarce as to the reason why femoral hernias are often missed and present as emergencies. Patients may be aware of groin discomfort or a groin lump, but they may not realise its clinical importance and may be reluctant to seek medical help. Initially some patients present to primary care with vague symptoms including groin discomfort that may be attributed to other disease such as osteoarthritis. As femoral hernias are typically small, they may be easily missed on examination, particularly in obese patients. Furthermore, owing to the difficulty in clinically distinguishing groin hernias, femoral hernias may be …

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